BasicPlus CPR, AED, and First Aid for Adults

StudentGuide

BasicPlusCPR, AED, andFirst Aid For Adults

DIGITAL STUDENT Guide –

Online Version

BasicPlusCPR, AED, and First Aid For Adults

Student Guide Version 7.0

Purpose of this GuideThis MEDIC First Aid BasicPlus Version 7.0Student Guide is solely intended to facilitate cer-tification in a MEDIC First Aid BasicPlus CPR,AED, and First Aid training class. The informationin this guide is furnished for that purpose and issubject to change without notice.

MEDIC First Aid certification may only be issuedwhen a MEDIC First Aid-authorized Instructor ver-ifies a student has successfully completed therequired core knowledge and skill objectives ofthe program.

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BasicPlus CPR, AED, and First Aid for Adults i

Table of ContentsThe First Aid Provider

The First Aid Provider .................... 1Legal Considerations .................... 3Recognizing an Emergency

and Deciding to Help ................. 4Personal Safety ............................. 6Disease Transmission and

Universal Precautions ................ 7Removing Contaminated Gloves

Skill Sheet 1 ................................... 9Emergency Medical Services

(EMS) ......................................... 10

Sudden Cardiac ArrestRespiratory and Circulatory

Systems ..................................... 12Sudden Cardiac Arrest .................. 13Early Defibrillation ......................... 14Chain of Survival ........................... 15

Basic CPR SkillsChest Compressions ..................... 16Chest Compressions

Skill Sheet 2 ................................... 17Rescue Breaths ............................. 18Rescue Breaths — CPR Mask

Skill Sheet 3 ................................... 20Rescue Breaths — CPR Shield

Skill Sheet 4 ................................... 21Primary Assessment —

Unresponsive Person ................ 22Primary Assessment —

Unresponsive PersonSkill Sheet 5 ................................... 23

Basic Life Support CareUnresponsive and Breathing ......... 24Unresponsive and Breathing —

Recovery Position Skill Sheet 6 ................................... 25

Unresponsive and Not Breathing ... 26Unresponsive and

Not Breathing — CPR Skill Sheet 7 ................................... 27

Automated External Defibrillators ... 28Basic AED Operation .................... 29Using an AED

Skill Sheet 9 ................................... 30Troubleshooting ............................. 31Other Considerations .................... 32

Foreign Body Airway ObstructionChoking ......................................... 33Choking

Skill Sheet 10 ................................. 34

First Aid AssessmentPrimary Assessment —

Responsive Person .................... 35Primary Assessment —

Responsive Person Skill Sheet 11 ................................. 36

Secondary Assessment ................ 37Secondary Assessment

Skill Sheet 12 ................................. 36

Caring for Serious InjuryControl of Bleeding ....................... 40Control of Bleeding

Skill Sheet 13 ................................. 41Internal Bleeding ........................... 42Managing Shock ........................... 43Head, Neck, or Back Injury ........... 44Brain Injury .................................... 45Spinal Motion Restriction

Skill Sheet 14 ................................. 46Swollen, Painful, Deformed Limb ... 47Swollen, Painful, Deformed Limb

Skill Sheet 15 ................................. 48

BurnsBurns ............................................. 49

Caring for Sudden IllnessWarning Signs of Sudden Illness ... 51Altered Mental Status .................... 52Stroke ............................................ 53Diabetic Emergencies ................... 54

Table of Contents

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ii BasicPlus CPR, AED, and First Aid for Adults

Table of Contents

Seizure ........................................... 55Breathing Difficulty, Shortness

of Breath .................................... 56Asthma .......................................... 57Severe Allergic Reaction ............... 58Pain, Severe Pressure, or

Discomfort in the Chest ............. 59Severe Abdominal Pain ................. 61

PoisoningIngested Poisoning ........................ 62Inhaled Poisoning .......................... 63

Environmental EmergenciesHeat Exhaustion ............................ 64Heat Stroke ................................... 65Hypothermia .................................. 66Frostbite ........................................ 67

Additional ConsiderationsEmergency Moves ......................... 68Emotional Considerations ............. 69

Specific First Aid Topics —Specific Injuries

Caring for Specific First AidProblems ................................... 70

Amputation .................................... 71Impaled Object .............................. 72Open Chest Injury ......................... 73Open Abdominal Injury .................. 74Impaled Object in the Eye ............. 75Chemicals in the Eye ..................... 76Nosebleed ..................................... 77Injured Tooth .................................. 78Pregnancy Complications ............. 79Bites and Stings ............................ 80Snakebites ..................................... 81Spider Bites ................................... 82Stinging Insects ............................. 83Tick Bites ....................................... 84Marine Animal Stings .................... 85Human and Animal Bites ............... 86

References and End Notes ...... 87

Glossary ....................................... 89

Class Evaluation ........................ 93

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The First Aid Provider


At work, injuries and illnesses kill about 2.2 million people in the world each year.i

Unintentional injury is the leading cause of death in the United States for individ-uals younger than 44 years of age. On average, 15 workers die each day in theU.S. from traumatic injuries, and more than four million workers suffer a nonfatalinjury or illness each year.ii

In the U.S., about one-third of all injuries and 20 percent of injury deaths occurat home. For every home injury death there are about 650 nonfatal home injuries.iii

Safe practices at work, home, and play can prevent many injuries, illnesses, anddeaths. However, once injury or sudden illness has occurred, effective first aidcan make the difference between a rapid or prolonged recovery, a temporary orpermanent disability, and even life or death.

The Occupational Safety and Health Administration, or OSHA, defines first aidas “emergency care provided for injury or sudden illness before professionalemergency medical treatment becomes available.”

BasicPlus CPR, AED, and First Aid for Adults 1

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2 BasicPlus CPR, AED, and First Aid for Adults

A first aid provider is some-one trained in the delivery ofinitial emergency procedures,using limited equipment toperform a primary assess-ment and intervention untilEmergency Medical Services,or EMS personnel arrive. Theessential responsibilities of afirst aid provider are:

� Recognizing a medicalemergency

� Making the decision tohelp

� Identifying hazards and ensuring personal safety

� Activating the EMS system

� Providing supportive, basic first aid care

The goal of this training is to help you gain the knowledge, skills, and confidencenecessary to manage a medical emergency until more advanced help is available.First aid does not require making complex decisions or having in-depth medicalknowledge. It is easy to learn, remember, and perform.

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Legal ConsiderationsSome people fear being sued as a result of performing first aid in an emergency.Understanding more about the legalities can help reduce this fear.

All states have passed what areknown as “Good Samaritan laws” tohelp encourage bystanders to assistthose in need. These laws help pro-tect anyone who:

� Voluntarily provides assistance,without expecting or acceptingcompensation,

� Is reasonable andprudent,

� Does not provide care beyondthe training received, and

� Is not “grossly negligent,” orcompletely careless, in deliver-ing emergency care.

Good Samaritan laws vary slightlyfrom state to state. Become familiarwith the laws in your state and otherstates where you work or travel.

Everyone has the right to refuse med-ical treatment. It is appropriate to aska responsive person if theywant help before providingcare. When a person is orbecomes unresponsive, thelegal concept of “impliedconsent” allows a provider tohelp without asking, becauseit assumes the person wouldagree to be helped if respon-sive.

Once care has begun, and itis safe to do so, remain withan ill or injured person untilsomeone with equal or

greater emergency medical trainingtakes over. If you are alone, it is okayto leave to activate EMS, but return tothe person as soon as you can.

There has never been a successfullawsuit in the United States against aperson providing first aid in goodfaith. Still, it is appropriate to usecommon sense:

� Activate EMS immediately.

� If the scene is unsafe, do notenter!

� Ask a responsive person forpermission before giving care.

� Never attempt skills thatexceed your training.

� And, once you have started,don’t stop until someone withequal or greater trainingrelieves you.

Duty to Act — A pre-determined requirement toprovide care, typically by job description (such asfirefighter, police officer, or lifeguard) or byrelationship (such as parent or guardian). In general,a first aid trained person is encouraged, but notrequired by duty, to act.

Negligence — Occurs when someone is causedfurther harm due to care that did not meet theexpected standard of someone with a duty to act.

Assault and Battery — Placing a person in fear ofbodily harm. Forcing care on a person against hiswishes may be considered grounds for this.

Other Legal Considerations


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Recognizing an Emergency andDeciding to Help

A general impression is a quick sense of what has occurred, or is occurring,when you first observe an emergency scene. This impression can help guide youin your approach.

If injured, how was the person injured? Injuries occur from physical force againstthe body. The manner in which that force creates an injury is called the Mecha-nism of Injury. Mechanisms that transfer significant force are best assumed toresult in serious injury until proven otherwise.

Does the person appear to be unresponsive? A person who is not moving andappears to have collapsed can be in a life-threatening condition known as suddencardiac arrest. Your immediate assessment and care can be his or her onlychance for survival.

The most critical decision you will make is whether to get involved when a medicalemergency has occurred. It is normal to feel hesitant because you are unsure ofyour ability to help.


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� You might hesitate because you feel like you are alone in helping. You areonly the first link in a pro gressive chain of emergency care. Your involve-ment lasts only until relieved by another first aid provider or respondingEMS providers — in most cases, a very short period of time.

� You might hesitate for fear of making things worse. Your basic first aidtraining provides you with sound knowledge and skills designed only tohelp — and not harm — those in need.

� You might also hesitate because you think you don’t have a lot of medicalknowledge. Extensive medical knowledge is not necessary. First aid skillsare based on common sense and simple, effective procedures that can beeasily learned and safely applied.

� Finally, you might hesitate because others have already stopped to help. Itnever hurts to see if additional assistance is needed. Other bystandersmay not have any first aid training or may be hesitant to provide care.

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Personal SafetyEmergency scenes are often unsafe. Your personal safety is always the highestpriority, even before the safety of an ill or injured person. Putting yourself in dangerto help someone can makethe situation worse.

Always pause for a momentbefore approaching an emer-gency and look for obvioushazards. Consider the possi-bility of hidden dangers. Ifthe scene is unsafe, do notapproach. If the location youare already in becomesunsafe, get out!

Respiratory ProtectionRespirators protect workers against insufficient oxygen environments, harmfuldusts, fogs, smokes, mists, gases, vapors, and sprays. These hazards may causecancer, lung impairment, other diseases, or death. Compliance with the OSHARespiratory Protection Standard could avert hundreds of deaths and thousandsof illnesses annually.

Confined SpacesConfined spaces are enclosed spaces that have limited or restricted entry andexit points. They are not intended for normal occupancy. Because of theirrestricted nature, these spaces can have a hazardous atmosphere lacking breath-able air. Without appropriate respiratory protection, anyone, including a rescuer,is at risk. Proper training, equipment, and experience in confined space rescueare essential before attempting to help in an emergency.

Material Safety Data SheetsA Material Safety Data Sheet, or MSDS, is a detailed document that describesthe physical and chemical properties, physical and health hazards, routes ofexposure, precautions for safe handling and use, emergency and first-aid proce-dures, and control measures for a specific chemical or sub stance. These sheetsare prepared by manu fac turers under OSHA regulation.


SETUP is an acronym that can help you rememberthe important points of making sure it is safe toprovide care:

� Stop — Pause to identify hazards� Environment — Consider your surroundings � Traffic — Be careful along roadways� Unknown Hazards — Consider things that

are not apparent� Personal Safety — Use protective barriers

SETUP

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Disease Transmission andUniversal PrecautionsWhen caring for someone, you can be exposed to blood or other potentiallyinfectious body fluids. While the risk of contracting a disease is extremely low, itis prudent to take simple measures to avoid exposure in the first place. Infectiousbloodborne diseases includeHepatitis B, Hepatitis C, andHIV, the virus that causesAIDS.

Exposure can occur throughthe direct contact of infec-tious material with an openwound or sore, or through themucous membranes of themouth, nose, and eyes.Exposure can also occurthrough a skin puncture witha contaminated sharp object.

Reducing exposure lowersthe chance of infection. “Uni-versal Precautions” is anapproach that recommendshandling all blood and otherbody substances as if theyare infectious. To be effec-tive, the approach is thesame for everyone, regard-less of relationship or age.

Disposable gloves are themost commonly used barrier.Make sure there is always afresh supply of gloves in yourfirst aid kit. Inspect gloves for damage or tears when you put them on. If they aredamaged, replace them immediately.

Always remove contaminated gloves carefully. Never snap them, as this maycause blood to splatter. Even after using gloves, use soap and water to cleanyour hands and any exposed skin. Use an alcohol-based hand sanitizer if soapand water are not available.

In 1991, the Occupational Safety and HealthAdministration (OSHA) released the BloodbornePathogens Standard to protect workers from therisk of exposure to bloodborne infectious diseases.The standard applies to anyone who hasoccupational exposure to blood or other potentiallyinfectious materials and provides information onhow to reduce the risk of exposure in the workplace.

Employees should review their company’sExposure Control Plan for site-specific informationon how to reduce exposure. More information canbe found at www.osha.gov and www.cdc.gov.

OSHA Bloodborne Pathogens Standard


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If a person requires rescuebreaths, use a shield or CPRmask with a one-way valveto minimize direct mouth-to-mouth contact.

A face shield can preventmouth, nose, and eye expo-sure when there is a possibil-ity of splashing or spraying.

If you don’t have personalprotective equipment duringa first aid situation, impro-vise. A towel, plastic bag, orsome other barrier can helpavoid direct contact.

A provider may elect not touse barriers, depending onhis relationship to the personand knowledge of the per-son’s health status.

Natural rubber latex allergy is a serious medicalproblem. Anyone who uses latex gloves frequentlyis at risk for developing it. Simple measures suchas the use of non-powdered latex gloves or non-latex alternatives can stop the development of latexallergy and new cases of sensitization.iv

Latex Allergy

Decontaminate all surfaces, equipment, and othercontaminated objects as soon as possible. Cleanwith a detergent and rinse with water. Use a bleachsolution of one quarter cup (.06 liter) of householdbleach per one gallon (3.79 liters) of water tosanitize the surface. Spray on the solution and leaveit in place for at least 2 minutes before wiping.

Decontaminating Surfaces

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Removing Contaminated GlovesSkill Sheet 1

Grasp First Glove� Always remove contami-

nated gloves carefully.Never snap them, as thismay cause blood to splatter.

� Without touching bare skin,pinch the glove at eitherpalm with the fingers of theopposite hand.

Remove Inside Out� Gently pull the glove away

from the palm and towardthe fingers, turning theglove inside out.

� Gather the glove you justremoved with your glovedhand.

Slide Finger UnderSecond Glove

� Without touching the out-side of the glove, carefullyslide your bare index fingerinside the wrist band of thesecond gloved hand.

Remove Inside Out� Gently pull outwards and

down, inverting the glove andtrapping the first glove inside.

� Throw away gloves in anappropriate container to pre-vent any further contact.

� Wash hands with soap andwater. If not available, washhands with an alcohol-basedhand rub.

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Emergency Medical Services (EMS)

Emergency Medical Services, or EMS, describes the emergency medicalresponse system developed within your community. An EMS system typicallyuses a specialized emergency communication network to gather information anddispatch appropriate emergency resources.

EMS providers within the system respond directly to emergency scenes, provideemergency medical care, and transport ill or injured people to a hospital.

One of your fundamental responsibilities as a trained provider is to activate theEMS system in an emergency. Immediate EMS activation is recommended when:

� A person is unresponsive

� A significant mechanism of injury has occurred

� A warning sign of serious illness exists

� The severity of a person’s condition is unclear.

Activating EMS usually consists of calling an easy-to-remember universal emer-gency telephone number, such as 911.


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Ideally, one person should call EMS while another person cares for the ill or injuredperson. An EMS dispatcher with specialized training will answer the call. The dis-patcher will ask for basic information, such as:

� The type of emergency

� Location

� The number and conditions of those who are ill or injured

� What care is being provided.

Answer the dispatcher’s questions as clearly as you can. Only hang up if directedto do so by the dispatcher.

You may have an emergencyaction plan (EAP) in yourworkplace that contains spe-cific procedures on how torespond to internal emergen-cies and activate EMS. It isimportant to become familiarwith the emergency planwhere you work.

The majority of medicalemergencies occur at home,so it is also smart to developa personal emergencyresponse plan for your homeand review it frequently withmembers of your household.

In the United States, the Occupational Safety andHealth Administration (OSHA) regulations requireemployers to have an emergency action plan (EAP)in writing, kept in the workplace, and available toemployees.ii In a typical workplace, the EAP shouldcontain specific procedures on the following:

� How designated first aid workplaceproviders are notified to respond

� What is expected of workplace providerswhen they respond

� How to activate EMS from the worksite� How to efficiently help EMS get to an ill or

injured personIt is important to become familiar with the properemergency response procedure in your workplace.

Emergency Action Plans

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Sudden Cardiac Arrest

Respiratory and Circulatory SystemsBecause the human body cannot store oxygen, it must continually supply tis-sues and cells with oxygen through the combined actions of the respiratory andcirculatory systems.

The respiratory systemincludes the lungs and the“airway”, the passage fromthe mouth and nose to thelungs. Expansion of thechest during breathingcauses suction, which pullsoutside air containing oxy-gen through the airway andinto the lungs. Relaxation ofthe chest increases the pres-sure within and forces air tobe exhaled from the lungs.

The circulatory systemincludes the heart and abody-wide network of bloodvessels. Electrical impulsesstimulate mechanical contractions of the heart to create pressure that pushesblood throughout the body. Blood vessels in the lungs absorb oxygen frominhaled air. The oxygen-rich blood goes to the heart and then out to the rest ofthe body.

Large vessels called arteries carry oxygenated blood away from the heart. Arteriesbranch down into very small vessels that allow oxygen to be absorbed directlyinto body cells so it can be used for energy production. Veins return oxygen-poorblood back to the heart and lungs where the cycle repeats.


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Sudden cardiac arrest, or SCA, can occur without warning to anyone, at anytime. It is one of the leading causes of death among adults in the United States.

Sudden cardiac arrest happens when the normal electrical impulses in the heartunexpectedly become disorganized. The normally coordinated mechanical con -traction of the heart muscle is lost, and a chaotic, quivering condition known asventricular fibrillation can occur.

Blood flow to the brain and body abruptly stops. The lack of blood and oxygento the brain causes the person to quickly lose consciousness, collapse, and stopbreathing.

Brain tissue is especiallysensitive to a lack of oxygen.When oxygen is cut off, braindeath can occur quickly,within a matter of minutes.Without early recognitionand care from a bystander,the person will not survive.

� Heart disease� Electrical shock� Severe blood loss� Drug overdose� Severe allergic reaction� Drowning

Causes of SCA


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Early DefibrillationCardiopulmonary resuscitation, or CPR, allows a bystander to restore some oxy-gen to the brain through a combination of chest compressions and rescuebreaths.

By itself, CPR is only a tem-porary measure that can buytime until more advancedcare can be provided. Themost effective treatment forventricular fibrillation is defib-rillation.

To defibrillate, electrodepads are applied to the chestand an electrical shock issent between the padsthrough the heart. This shockstops ventricular fibrillation,so the heart’s normal electri-cal activity can return and restoreblood flow.

Successful defibrillation is oftendependent on how quickly a personis defibrillated. For each minute a per-son is in cardiac arrest, his/herchance of surviving decreases byabout 10 percent. After as little as 10minutes, defibrillation is rarely suc-cessful. The amount of time it takesto recognize a problem, activate EMS,and have EMS respond and defibril-late is usually longer than 10 minutes.In most cases, it’s too late.

An automated external defibrillator, orAED, is a small, portable, computer-ized device that is simple for a mini-mally trained bystander like you tooperate.

Turning on an AED is as simple asopening a lid or pushing a power but-ton. Once it is on, an AED will providevoice instructions to guide youthrough its use.

An AED automatically analyzes theheart rhythm, determines if a shock isneeded, and charges itself to beready to defibrillate. An operator sim-ply pushes a button to deliver theshock when told to by the AED.

In many cases of sudden cardiacarrest, if defibrillation can be deliveredsooner, before EMS arrives, morepeople would survive. Immediate,high-quality CPR and defibrillationwith an AED from a bystander candouble or even triple the chance forsurvival.


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Chain of Survival

The Chain of Survival is used to describe the most effective approach for treatingsudden cardiac arrest. It consists of five interdependent links:

� Immediate recognition and activation of EMS quickly initiates the treat-ment process.

� Early CPR with effective chest compressions buys time for accessing anAED and improves the chance that defibrillation will work.

� Rapid defibrillation provides the best chance to return the heart to a nor-mal rhythm.

� Effective advanced life support procedures and medications used byparamedics, nurses, or doctors help sustain the chance for recovery andsurvival.

� And finally, integrated post-cardiac arrest care increases the likelihood oflong-term survival.

If any one of the links is weak or missing, the chances for survival are greatlyreduced. The greatest chance for survival exists when all links are workingtogether.


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Basic CPR Skills

Chest Compressions

If the heart stops, it is possible to restore at least some blood flow through thecirculatory system by way of external chest compressions. The most effectivechest compressions occur with the rhythmic application of downward pressureon the center of the chest.

External compressions in crease pressure inside the chest and directly compressthe heart, forcing blood to move from the heart to the brain and other organs.

Always compress fast and deep when performing compressions. Without losingcontact, allow the chest to fully rebound at the top of each compression.

Blood pressure is created and maintained with well-performed compressions. Ifcompressions stop, pressure is quickly lost and has to be built up again. Minimizeany interruptions when doing compressions.

When compressing properly, you may hear and feel changes in the chest wall.This is normal. Forceful external chest compression is critical if the person is tosurvive.


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Basic CPR Skills


Chest CompressionsSkill Sheet 2

� Position person face up onflat, firm surface. Kneelclose to chest. Place heel ofone hand on center ofchest.

� Place heel of second handon top of first. You can inter-lace your fingers to helpkeep off chest.

� Position your shouldersdirectly above your hands.Lock your elbows and useupper body weight to push.

� Push hard, straight down atleast 2 inches. Lift handsand allow chest to fullyrebound.

� Without interruption, pushfast at a rate of at least 100times per minute.

� Keep up the force andspeed of compressions.

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Basic CPR Skills

Rescue Breaths

Rescue breaths are artificial breaths given to someone who is not breathing. Theyare given by blowing air into the mouth to inflate the lungs. The air you breathecontains about 21% oxygen. Your exhaled air still contains up to 16–17% oxygen.This exhaled oxygen is enough to support someone’s life for a short time.

Before giving rescue breaths, you need to make sure there is an open airway. Theairway is the only path for getting air into the lungs.

Someone who is unresponsive can lose muscle tone. If flat on his/her back, thiscan cause the base of the tongue to relax and obstruct the airway. This is themost common cause of a blocked airway in an unresponsive person.

The tongue is attached to the lower jaw. Moving the jaw forward lifts the tongueaway from the back of the throat and opens the airway.

The head tilt, chin lift airway technique is the recommended way to open andmaintain an airway. Place one hand on the forehead. Place the fingertips of yourother hand under the bony part of the chin. Apply firm, backward pressure on theforehead while lifting the chin upward. This will tilt the head back and move thejaw forward.


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Basic CPR Skills

Maintain the head-tilt withyour hand on the forehead.Avoid pressing into the softtissue of the chin with yourfingers, as this can alsoobstruct the airway. Leavethe mouth slightly open. Ifyou remove your hands, theairway will close again. Openthe airway each time yougive rescue breaths.

When caring for someonewho is seriously injured,establishing an open airwayis a higher priority than protecting a possible injury to the spine. Without an airwaya person will not survive, regardless of illness or injury.

As a trained provider, you should use a protective barrier such as a CPR mask,or shield when giving rescue breaths, to minimize your exposure to infectiousdisease.

When giving breaths,avoid blowing too hard ortoo long. Air can bepushed into the stomach,making additional breathsmore difficult and increas-ing the chance of vomit-ing. If you cannot get thechest to rise with your firstbreath, reposition thehead further back byusing head-tilt, chin liftagain, and try anotherbreath.


Unprotected Rescue BreathsA provider may elect not to use barriers, dependingon his or her relationship to the person andknowledge of the person’s health status. Directmouth-to-mouth rescue breaths can be performedusing the same technique as with a CPR shield.

Mouth-to-nose rescue breaths may be useful if youhave difficulty with mouth-to-mouth. Tilt the headback and close the mouth when lifting the chin.Seal your mouth around the nose and blow.

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Basic CPR Skills


Rescue Breaths — CPR MaskSkill Sheet 3

Position Mask� Inspect mask to make sure

one-way valve is in place.� Place mask flat on person’s

face by laying top of maskover bridge of nose.

� Use thumb and forefinger tocontrol the top of mask.

� Use thumb of other hand tocontrol the bottom of mask.

Open Airway� Hook fingertips of hand

controlling bottom ofmask under bony part ofchin.

� Tilt head and lift chin. Thisbrings the face up into themask, creates an airtightseal, and opens the airway.

Give Breath� Take a normal breath and

blow through valve open-ing to deliver breaths.

� Each breath is 1 second inlength. Create a visiblerise of chest, but no more.

� Remove your mouth andlet person exhale com-pletely. Take a fresh breathbetween breaths.

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Basic CPR Skills


Rescue Breaths — CPR ShieldSkill Sheet 4

Position Shield� Place breathing port of

shield over or into mouth.� Spread shield flat over

face.

Open Airway� Place one hand across

forehead. � Hook fingertips of your

other hand under bonypart of chin.

� Tilt head and lift chin.

Give Breath� Pinch nostrils to seal nose.� Take a normal breath.

Open your mouth wide.Press it on shield aroundperson’s mouth to createairtight seal. Blow throughshield to deliver breath.

� Each breath is 1 second inlength. Create a visiblerise of chest, but no more.

� Remove your mouth andlet person exhale com-pletely. Take a fresh breathbetween breaths.

NOTE: The same technique can be used to provide mouth-to-mouth rescue breaths if you elect to not use abarrier device.

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Primary Assessment — Unresponsive PersonThe primary assessment helps you assess for immediate life-threatening prob-lems, activate the EMS system, and rapidly provide priority care. It is the samefor all ages and is performed quickly.

� Before anything else,pause and assess thescene for hazards. Ifthe situation is danger-ous to you, do notapproach.

� Tap or squeeze theperson’s shoulder andask loudly, “Are youokay?” Use the per-son’s name if youknow it.

� If the person isunresponsive, have another bystander activate EMS. If you are alone withan unresponsive adult, immediately alert EMS yourself. Get an AED, if oneis available, and quickly return to the person.

� Look at the face and chest for normal breathing. Do this quickly. Normalbreathing is effortless, quiet, and regular. If normal breathing is found,place the person on his or her side in the recovery position.

Weak, irregular gasping,snorting, or gurgling soundscan occur early in cardiacarrest. These actions provideno usable oxygen. This is notnormal breathing. If some-one is not breathing, or onlygasping, perform CPR. Usethe AED as soon as onebecomes available.

Basic CPR Skills

Assess, alert, and attend is a convenient way of re -mem bering the general approach to a primaryassessment. Assess the scene and person, alert oractivate EMS, and attend to the person’s problemuntil EMS arrives.

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Basic CPR Skills


Primary Assessment — Unresponsive PersonSkill Sheet 5

Assess Scene � Pause and assess scene for

safety.� If unsafe, or if it becomes

unsafe at any time, GETOUT!

Check for Response � Tap or squeeze shoulder.

Ask loudly, “Are you okay?”� Use person’s name if known.� If unresponsive, have

someone activate EMSand get an AED. If you arealone, place in a recoveryposition and do thisyourself.

Look for Normal Breathing� Position person face up

on a firm, flat surface.� Look quickly at face and

chest for normal breath-ing. It is effortless, quiet,and regular.

� Weak, irregular gasping,snorting, or gurgling isNOT considered normal.

Provide Indicated Care � If normal breathing is found,

place an uninjured personon side in a recovery posi-tion.

� If person is not breathing, oronly gasping, perform CPR.

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Basic Life Support Care


Unresponsive and Breathing

Even if a person is breath-ing normally, a lack ofresponsiveness is still con-sidered to be a life-threaten-ing condition that requiresimmediate care.

There are a variety of thingsthat can result in unrespon-siveness, including medicalconditions such as stroke orseizures, or external factors,such as alcohol or drug over-dose. Regardless of thecause, the greatest treatment concern is the ability of the person to maintain aclear and open airway.

Positioning an uninjured, unresponsive person in the recovery position can helpmaintain and protect the airway. This position uses gravity to drain fluids from themouth and keep the tongue from blocking the airway.

If an unresponsive person has been seriously in jured, do not move the personunless fluids are collecting in the mouth and airway, or you are alone and needto leave to get help.

Frequently assess thebreathing of anyone placedin a recovery position. Thecondition can quicklybecome worse and requireadditional care.

This version of the recovery position is alsodescribed as the High Arm in Endangered Spine, orHAINES, position and can be used when someoneis injured.

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Unresponsive and Breathing — Recovery PositionSkill Sheet 6

Assess Person� If safe, tap or squeeze

shoulder. Ask loudly, “Areyou okay?”

No response!� Have someone alert EMS

and get an AED.� Look quickly at face and

chest for normal breathing.Normal breathing present!

Prepare� Extend arm nearest to you

up alongside head. � Bring far arm across chest

and place back of handagainst cheek.

� Grasp far leg just aboveknee and pull it up so foot isflat on ground.

Roll� Grasp shoulder and hip and

roll patient toward you. Rollin a single motion, keepinghead, shoulders, and torsofrom twisting.

� Roll far enough for face tobe angled forward.

� Position elbow and knee tostabilize head and body.

Suspected Injury� If person has been seriously

injured, do not move unlessfluids are collecting in air-way, or you are alone andneed to leave to get help.

� During roll, make sure headends up resting onextended arm and head,neck, and torso are inline.

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Unresponsive and Not BreathingWhen a person is unresponsive and does not appear to be breathing or is onlygasping, she is considered to be in cardiac arrest and requires CPR. CPR restoressome oxygen to the brainthrough a combination ofchest compressions and res-cue breaths.

Once you start CPR, do thebest you can. A person with-out breathing or circulationcannot survive. Nothing youdo can make the outcomeworse.

It is unlikely a person willimprove with CPR alone.However, if a person startsmoving, or shows other obvi-ous signs of life during CPRstop and check for normalbreathing. If normal breath-ing is present, place the per-son in the recovery positionand monitor breathing.

If you are unable or unwillingto give rescue breaths, per-form compression-only CPR.Without interruption, provideongoing compressions at arate of at least one hundredtimes per minute until anAED is ready, anotherprovider or EMS personneltake over, or you are tooexhausted to continue. Ifothers are available, switchcompressors about every 2minutes.


� Fluids in Airway — Roll person on side toquickly drain fluids. Roll without twisting,like a log. Remove any material still in mouthwith a gloved finger.

� Cold Environments — Handle cold peoplegently to prevent cardiac arrest. If body issolid, do not start CPR.

� Drowning — As quickly and safely aspossible, get person onto solid ground.Expect vomiting. Do not attempt to expelwater using abdominal thrusts.

� Serious Injury — Someone in cardiac arrestdue to injury is unlikely to survive. If it isclear injury has caused arrest, do not startCPR.

� Electric Shock/Lightning — Approach onlyif it is safe. Electric shock can causeventricular fibrillation. When safe, performCPR and use an AED.

� Neck Breather — Provide rescue breathsthrough surgical opening, or stoma, in neckusing CPR mask or shield.

Special CPR Situations

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Unresponsive and Not BreathingSkill Sheet 7

Assess Person� If safe, tap or squeeze

shoulder. Ask loudly, “Areyou okay?”

No response!� Have someone alert EMS

and get an AED. � Look quickly at face and

chest for normal breathing.Normal breathing absent!

Give 30 Compressions� Place heel of one hand on

center of chest. Place heelof second hand on top offirst.

� Using upper body weight,push hard, at least 2 inches.

� Push fast, at least 100 timesper minute. Allow chest tofully rebound.

Give 2 Rescue Breaths� Tilt head; lift chin to estab-

lish airway.� Make chest visibly rise with

each breath, but no more. � Take a fresh breath between

breaths.

Repeat Cycles� Provide continuous cycles

of 30 compressions and 2rescue breaths.

� If an AED becomes available,turn it on immediately andfollow the AED’s voiceinstructions.

� Continue until another pro -vider or EMS personnel takesover, the person shows signsof life, or you are too tired.

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Automated External Defibrillators

AEDs are designed to be simple to operate. Voice, lights, and screen instruc-tions guide an operator in using the device. There are many different brands ofAEDs, but the same basic steps for operation apply to all of them.

� Turn on the AED. This starts voice instructions and readies the device foruse. Opening the lid will turn on the power with some AEDs. With others,a power button is pressed.

� Adhere the defibrillation pads to the person’s bare chest. Pads are placedto direct the electrical shock through the heart. Most pads are pre-con-nected to the device, but some AEDs require you to plug in a connector.

� Allow the AED to analyze the heart rhythm. An AED automatically startsanalyzing once the pads are in place. If defibrillation is required, the AEDwill charge to get ready for shock delivery.

� Safely deliver a shock if directed to by the AED. Keeping others clear, abutton is pressed on most AEDs to deliver a shock. Immediately after ashock is delivered,CPR is resumed. Voiceinstructions and addi-tional analysis by theAED will guideproviders through fur-ther care.


Some AEDs deliver a shock automatically aftercharging. An accidental shock can be prevented bymaking sure no one is in contact with the personbeing defibrillated.

Automatic Shock Delivery

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Basic AED OperationIf someone is unresponsive and not breathing, perform CPR until an AED is readyto analyze the heart rhythm. Defibrillation pads must be applied to a bare chest.If needed, quickly tear or use scissors to remove clothing, including undergar-ments. If the chest is wet orsweaty, wipe it dry with theremoved shirt, a dressing, ora towel.

The pads have pictures onthem to assist in properplacement. Carefully look atthe pictures to ensure thepads are accurately placed.Pads use an adhesive tostick to the chest. Peel thepads from the backing sheetone at a time and place themexactly as indicated in thepictures.

AEDs automatically startanalyzing once the pads arein place. Movement caninterrupt the analysis. Be cer-tain that no one is touchingthe person.

If defibrillation is required, anAED will charge to deliver ashock. A voice instructionwill indicate when the AED isready. To prevent accidental shock, keep others clear. Give a verbal warning andlook to make sure no one, including you, is in contact with the person beforedelivering the shock.

Immediately after delivering the shock, resume CPR, starting with chest com-pressions.

If the person responds, stop CPR and place him in a recovery position. Leave theAED on and attached in case cardiac arrest returns.

When a shock is not indicated by the AED, simply resume CPR, starting withchest compressions and continue to follow any voice instructions.

More and more employers are implementing AEDpro grams in the workplace to improve survival fromsudden cardiac arrest. In the community, publicaccess AED programs are installing AEDs in publicareas to be used by bystanders in an emergency.

CPR training should include training in the use ofan AED, even if one is not currently available in yourworkplace.

AEDs


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Using an AEDSkill Sheet 9

Perform CPR� If person is unresponsive

and not breathing, immedi-ately perform CPR.

� Provide continuous cyclesof 30 compressions and 2rescue breaths.

When Available, Attach AED� Turn on AED and bare chest.� Peel first pad from backing

and place below right collar-bone, above nipple, andbeside breastbone.

� Place second pad on leftside, over ribs, and a fewinches below armpit.

If Indicated, Deliver Shock� Allow AED to analyze heart.

Stop all movement.� If shock is advised, CLEAR

everyone and press buttonto deliver shock.

� If a shock is NOT advised,immediately resume CPR,starting with chestcompressions.

Resume CPR � Quickly resume CPR, start-

ing with chest compres-sions. Follow any additionalvoice instructions from AED.

� Continue until anotherprovider or EMS personneltake over.

� If person responds, stopCPR and place in recoveryposition. Leave AED on andattached.

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Troubleshooting

AEDs are designed to detect problems during use and guide you through cor-rective actions. If a troubleshooting message occurs, stay calm and follow theAED’s voice instructions.

If the AED indicates a problem with the pads, the pads are not completelyadhered to the skin or there is a poor connection to the AED.

Press pads firmly, especially in the center, to make sure they are adhering well.

� Make sure the pads cable connector is firmly connected to the AED.

� If the chest is wet, remove pads and wipe the chest dry. If pads do notstick due to chest hair, pull the pads off and quickly shave the hair. Applya new set of pads.

Another troubleshooting message may indicate that analysis has been interrupteddue to movement. Stop all sources of movement, such as chest compressionsor rescue breaths.

If a message indicates the need to replace a battery, there may only be enoughenergy for a limited number of shocks. If the AED fails to operate, the depletedbattery should be removed and replaced with a new one.


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Other ConsiderationsA person should be removed from standing water before an AED is used. It isokay to use an AED when a person is lying on a wet surface, such as in the rainor near a swimming pool. An AED should never be immersed in water or have flu-ids spilled on it.

AEDs can also be usedsafely on metal surfaces,such as gratings or stair-wells. Make sure pads donot directly touch any metalsurface.

Someone may have a surgi-cally implanted device in thechest, such as a pacemakeror an automated internaldefibrillator. A noticeablelump and surgical scar willbe visible. If the implanteddevice is in the way of cor-rect pad placement, place the pads so the edges are at least one inch away fromthe device.

Defibrillating over medicationpatches could reduce theeffectiveness of the shock. Ifa medication patch is inter-fering with placement, use agloved hand to peel off thepatch and wipe away anyremaining residue beforeplacing pads.


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Foreign Body Airway Obstruction

ChokingChoking can occur when a solid foreign object, such as a piece of food or smallobject, enters a narrowed part of the airway and becomes stuck. On inhalation,the object can be drawn tighter into the airway and block air from entering thelungs. Your help is required to save the person’s life.

A forceful thrust beneath theribs and up into the dia -phragm can compress theair in the chest and buildenough pressure to “pop”the object out of the airway.Direct compression of thechest over the breastbonecan also create enough pres-sure to expel an object.

You must be able to recog-nize the difference betweena mild blockage and a severeblockage.

With a mild blockage, a per-son can speak, cough, orgag. This type of blockage istypically cleared by cough-ing. Encourage someonewith a mild blockage tocough forcibly. Stay closeand be ready to take action ifthings worsen.

When a severe blockageoccurs, a person cannot dis-lodge the object on his own.Signs of severe obstruction include very little or no air exchange, lack of sound,and the inability to speak or cough forcefully. The person may hold his hands tohis throat as he attempts to clear the obstruction.


When someone is clearly pregnant or obese, usechest thrusts instead of abdominal thrusts.

Pregnant or Obese

If you are alone, try pressing your abdomen quicklyagainst a rigid surface, such as the back of a chair.If one is not available, attempt abdominal thrustson yourself.

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Foreign Body Airway Obstruction


ChokingSkill Sheet 10

Assess Person� Ask, “Are you choking?”� If person nods yes, or is

unable to speak or cough— act quickly!

� If available, have abystander activate EMS.

Position Yourself � Stand behind person.

Reach around and locatenavel.

� Make a fist with other handand place thumb sideagainst abdomen, justabove navel and below ribs.

� Grasp fist with other hand.

Give Thrusts� Quickly thrust inward and

upward into abdomen.� Repeat. Each thrust needs

to be given with intent ofexpelling object.

� Continue until person canbreathe normally.

If Person BecomesUnresponsive…

� Carefully lower to ground.� If not already done, activate

EMS.� Begin CPR, starting with

compressions. � Look in mouth for an object

before giving rescue breaths.Remove any object if seen.

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First Aid Assessment

Primary Assessment — Responsive PersonJust as with an unresponsive person, the primary assessment for someone whois responsive is to assess for and immediately treat life-threatening problems,including bleeding and shock.

If it is safe for you to ap -proach, do so. Introduceyourself. Let the personknow you are first aid trainedand there to help. Check forconfusion or disorientation.

Assess for any difficulty inbreathing.

Scan the body for seriousbleeding. If found, control itimmediately.

Check the face for tissuecolor. Tissue color dependson the amount of blood circulating below the skin.

� Normal tissue color is light pink.

� Paleness can indicate blood loss or shock.

� A bluish color can indicate a lack of oxygen.

When checking a dark-skinned person for tissue color, assess the palms of thehands, fingernails, or inside the lip.

Assess skin temperature bytouching the forehead withyour bare wrist.

� Normal skin feelswarm and dry.

� Cool, wet skin can bean indication of shock.

Quickly activate EMS andprovide any primary carewhen a life-threatening med-ical condition is found orsuspected.


Emergencies are dynamic events that can changeat any time. Reassessment is the ongoing obser va -tion of an ill or injured person to monitor his or hercondition and the effectiveness of first aid.

Make sure the situation remains safe for you to bethere. Watch for changes in a person’s level ofresponsiveness. Ensure the airway is open andclear and that the person is breathing normally.Reassess to ensure external bleeding is controlled.Look for changes in the person’s tissue color or skintemperature. Check at regular intervals until anotherprovider or EMS personnel take over.

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Primary Assessment — Responsive PersonSkill Sheet 11

Assess Scene� Pause and assess scene for

safety.� If unsafe, or if it becomes

unsafe at any time, GETOUT!

� If safe, approach the per-son.

Introduce Yourself� Let the person know you

are first aid trained andthere to help.

� Check for a diminished levelof responsiveness.

� Assess for any difficulty inbreathing.

Check for Bleeding� Scan the body for any

heavy bleeding. � If found, control it immedi-

ately.

Check Tissue Color andBody Temperature

� Look at the face to checktissue color. When checkinga dark-skinned person fortissue color, assess thepalms of the hands, finger-nails, or inside the lip.

� Touch the forehead withyour bare wrist to assessbody temperature.

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Secondary AssessmentWhen a primary assessment indicates no life-threatening problems, completea secondary assessment to gather additional information.

Quickly try to determine theperson’s chief complaint. Askwhat happened. If she can-not answer, ask bystanders.The person may have amedical alert bracelet ornecklace identifying a med-ical condition that couldbe related to the currentproblem.

The mechanism or forcesthat caused an injury mayhelp predict the presence ofa hidden injury. Clues in theenvironment, such as the temperature, or the presence of medications or con-tainers, may help identify the cause of the chief complaint.

Physically assess the per-son. Briefly assess the bodyfrom head to toe, and lookand feel for signs of illnessand injury.

The DOTS acronym helps toremind you what to look for:

� Deformities

� Open injuries

� Tenderness

� Swelling

If needed, remove or cutaway clothing to get a betterlook at an affected body part. Compare one side of the body to the other. If atany time you suspect spinal injury, immediately provide spinal motion restrictionby manually stabilizing the head.

When there are multiple people affected in anemergency, it is important to treat the mostseriously ill or injured people first. Triage, a Frenchword meaning “to sort,” is used to describe theprioritization process. To complete triage quickly,prioritization is done in a logical manner:

� Immediate: Life-threatening problems thatneed immediate intervention

� Delayed: Serious injuries that needintervention, but can wait for it

� Minor: Injuries that may need intervention orbe ok without it

� Deceased: No signs of life, obviously dead

Multiple Victims


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Ask questions. Use the acronym SAMPLE to help you remember what to askabout.

� Symptoms — Things the person is feeling, such as pain, nausea, dizzi-ness, or anything related to the situation.

� Allergies — Things the person may be allergic to.

� Medications — Medications the person has been prescribed or is taking.

� Past medical history — Medical problems that may be related to what isgoing on.

� Last oral intake —When the person lastate or drank.

� Events leading up toproblem — What theperson was doing justprior to the problem.

If you find or begin to sus-pect a life-threatening prob-lem is occurring whileperforming a secondaryassessment, stop, quicklyactivate EMS, and providethe primary care.

Suspect spinal injury if an injured person has any ofthe following risk factors:

� Age greater than 65 years� Driver, passenger, or pedestrian in a motor

vehicle, motorized cycle, or bicycle crash� A fall from greater than standing height� Tingling in the extremities� Pain or tenderness in the neck or back� Sensory loss or muscle weakness involving

the torso or upper extremities� Not fully alert or intoxicated� Other painful injuries, especially of the head

and neck� Children 2 years of age or older with

evidence of head or neck trauma

Mechanism of Injury

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Secondary AssessmentSkill Sheet 12

Determine Chief Complaint� Ask what happened. If per-

son cannot answer, askbystanders.

� Look for medical alertbracelet or necklace.

� Determine if any mechanismor force occurred that couldhave caused a serious injury.

Look at the Person� Briefly check body from

head to toe. Look and feelfor signs of illness and injury(DOTS):– Deformities– Open injuries– Tenderness– Swelling

Ask Questions� Ask questions related to

what is going on (SAMPLE):

– Symptoms?

– Allergies?

– Medications?

– Past medical history?

– Last oral intake?

– Events?

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Caring for Serious Injury

Control of Bleeding

Blood vessels are present throughout the body. Bleeding occurs when tissuesare damaged. Heavy bleeding is likely if a major blood vessel is damaged. Bleed-ing reduces the oxygen-carrying capacity of blood. If heavy or uncontrolled,bleeding can quickly become life threatening.

Arterial bleeding is bright red and will often spurt from a wound. It can be difficultto control due to the pressure created by the heart’s contractions.

If the blood is dark red and flowing steadily, it is likely coming from a damagedvein. Bleeding from a vein can be heavy. Regardless of the source, all heavybleeding must be controlled as soon as possible.

Clot-forming fibers naturally collect at a wound site to create a patch to stopbleeding. Severe bleeding can overwhelm this process and prevent clotting fromoccurring.

Activate EMS immediately for any heavy bleeding.

Bleeding exposes you, the provider, to potentially infectious body fluids. Alwaysuse protective barriers, such as disposable gloves, to protect both you and theinjured person.

Continuous firm and direct pressure applied to a wound is the best method forcontrolling external bleeding.

When barriers are not available, an injured person can provide self-care or aprovider can use improvised barriers, such as a plastic bag.


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Control of BleedingSkill Sheet 13

Apply Direct Pressure� Quickly expose and inspect

wound.� Using a clean, absorbent

pad, apply direct pressurewith flats of fingers directlyon point of bleeding.

� If a pad is not available,apply direct pressure withjust your gloved hand.

Apply Pressure Bandage� Wrap a roller gauze or elas-

tic bandage around limband over injury to providecontinuous pressure towound.

� Include enough pressure tocontrol bleeding.

� Avoid wrapping so tight thatskin beyond bandagebecomes cool to touch,bluish, or numb. Make surea finger can be slippedunder bandage.

If Bleeding Continues…� If blood soaks through the

pad, apply another pad,leaving the initial pad inplace.

� Apply more pressure withthe palm of your hand.

� When direct pressure is noteffective at controllingbleeding from a limb, applya tourniquet only as a lastresort.

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Internal Bleeding

A significant blow can create injury and bleeding inside the body. This is espe-cially true for organs in the chest and abdomen. Internal bleeding can be difficultto detect. Suspect it if the chest or abdomen is hit hard.

Surgery may be the only way to control internal bleeding. Early suspicion andactivation of EMS is critical for effective treatment, and possibly survival.


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Managing ShockShock develops when poor blood flow creates a shortage of oxygen to bodytissues. Any serious illness or injury has the potential to cause shock. If not treatedearly, shock can get worse and become life threatening.

Shock is progressive innature. Early signs can bedifficult to detect. A personmay simply appear uneasy,restless, or worried.

Other more serious signscan emerge gradually overtime. Responsiveness maydiminish. The skin maybecome pale, cool, andsweaty.

A person in shock must getto a hospital as quickly aspossible in order to survive.Early recognition, treatment, and acti-vation of EMS are essential for sur-vival.

To limit the effects of shock, help thebody maintain adequate oxygen by:

� Ensuring an open and clearairway

� Ensuring normal breathing

� Controlling any externalbleeding.

� If there is no difficulty in breath-ing, lay the person flat on theground.

� Maintain a normal body tem-perature. Insulate on top andunderneath with a blanket toprevent heat loss. Be carefulnot to overheat. If you suspecta head or back injury, do notmove the person to put a blan-ket underneath. Tuck the blan-ket underneath as much aspossible.

� Give nothing to eat or drink,even if the person asks for it.Keep the person as comfort-able and calm as possible.Reassess regularly until anotherprovider or EMS take over.


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Head, Neck, or Back InjuryWhen the body suffers a significant force, such as from a high fall, shooting,or motor vehicle crash, serious injury can result, most notably to the spine. Injuryto the spinal cord can result in temporary or permanent paralysis or in a life-threat-ening condition, such as the loss of breathing.

After the initial injury, move-ment of damaged spinalbones can result in additionalinjury to the spinal cord orsurrounding tissue. This canresult in permanent damage.

Quickly instruct a responsiveperson to remain still. Askabout how the injuryoccurred. Look for any obvi-ous injury to the head, neck,or back. Ask about numb-ness, tingling, burning, orloss of sensation in the armsor legs. The lack of obvious injury does not mean that the spine is not injured. Ifa significant mechanism of injury occurred, it is best to assume a spinal injuryexists.

The priority of care is to help prevent further injury by keeping the injured personstill and using spinal motion restriction. Always make sure it is safe to providecare.

Establishing an airway for an unresponsive person is a higher priority than pro-tecting suspected injury to the spine. Tilt the head and lift the chin when it is nec-essary to maintain an openairway or give rescuebreaths. If you need to leavean unresponsive person witha suspected spinal injuryalone to get help, place theperson in a recovery positionto protect the airway beforeyou go.

Pain and loss of function usually accompany aspinal injury, but the absence of pain does notmean that the victim has not been significantlyinjured. If you suspect a victim could possibly havea spinal injury, assume they do!

CAUTION!


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Brain InjuryA significant blow or force to the head can result in internal injury to the brainand soft tissues within the skull. Swelling or bleeding from the injury can causeincreasing pressure within the skull and damage the delicate brain tissue.

Suspect a brain injury whena blow to the head results inconfusion or disorientation.Surgical intervention may bethe only treatment. ActivateEMS immediately and pro-vide spinal motion restriction.

If a bleeding wound is pres-ent, place an absorbent paddirectly over the area andcarefully apply firm, continu-ous pressure. Do not try tostop the flow of blood or fluidfrom the ears or nose.

Closely monitor the person’s level of responsiveness. If fluid accumulates in themouth or vomiting occurs, roll the person onto his or her side to protect theairway.

If the person has a seizure,maintain spinal motionrestriction and protect him orher from bumping intonearby objects. Do notrestrain the person tightlyand do not place anything inhis or her mouth. Seizuresgenerally last for just a fewminutes.



A blow or force to the head can cause a concussionor mild injury to the brain. This can result inproblems with concentration, memory, judgment,balance, and coordination. The effects of mostconcussions are temporary and will resolvenaturally.

Concussion

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Spinal Motion RestrictionSkill Sheet 14

Initial Considerations� Make sure it is safe to pro-

vide care.� Immediately encourage per-

son to not move.� Have a bystander activate

EMS.

Stabilize Head� Get into a comfortable posi-

tion behind the person.� Cup your hands on both

sides of the head, withoutcovering the ears, to manu-ally stabilize head.

� Keep the head, neck, andspin in line. Minimize anymotion.

� Comfort, calm, and reassurethe person.

Protect Airway� If fluids are collecting in

mouth and airway, roll per-son onto side to drain.

� If you are alone and need toleave to get help, roll personinto recovery positionbefore you go.

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Swollen, Painful, Deformed LimbBones, muscles, and joints give the body shape, allow movement, and protectvital internal organs. Long bones form the upper and lower parts of each limb.Muscles, ligaments, and tendons attach to the bones, allowing for movementwhere the bones come together at joints. These bones are the most exposed toexternal forces and injury.

There are four different typesof injuries affecting bones,muscles, and joints:

� Strains are stretchingor tearing injuries tomuscles or tendons.

� Sprains are tearing in -juries to ligaments thathold joints together.

� Dislocations are theseparation of boneends at a joint.

� Fractures are breaks in bones.

Distinguishing an injury to muscle or bone is often difficult. It is best to treat themall as possible fractures.

Common signs of these injuries in clude swelling, pain, and discoloration. The limbmay appear deformed and the person may be guarding it by holding it against hisbody.

Unstable bones or joints can damage tissue, muscle, blood vessels, and nerveswhen moved.

Do not allow the person to use the injured limb. Movement can cause further injury.

An open wound may be present. If needed, expose the injury site by gently cuttingor tearing away clothing. Cover an open wound with a clean absorbent pad andgently control bleeding with firm, continuous, direct pressure. Never push a boneback under the skin.

Splinting an injured limb canreduce pain and prevent fur-ther injury. In general, it isbest to rely on EMS person-nel to splint, as they havemore extensive training,experience, and equipment.

For many injuries, local cooling can help decreasebleeding, swelling, and pain. A plastic bag filledwith a mixture of ice and water works best. Place athin cloth between the bag and skin to preventcold-related problems. Limit application to 20minutes or less.

Local Cooling


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Swollen, Painful, Deformed, LimbSkill Sheet 15

Expose Injury� Encourage person not to

move injured limb. � Expose injury site to look for

an open wound.

Cover Open Wounds� Cover an open wound with

a clean absorbent pad.� Gently control bleeding with

firm, continuous, directpressure around bone orinjury site.

� Never push an exposedbone back under skin.

Stabilize Limb� Leave injured limb in posi-

tion it was found. � Use padding in gaps and

holes underneath limb toprovide a stable and com-fortable spot for it to rest.

� If needed, place your handsabove and below injury tomanually stabilize limb.

Additional Considerations� If injury seems serious, or

you are not sure, activateEMS.

� Comfort, calm, and reassureperson.

� Local cooling can helpdecrease bleeding, swelling,and pain.

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Burns

BurnsBurns can inflict serious physical damage to the body. Typically caused by closeexposure to high temperatures, chemical reactions, or electrical current, burnscan vary in severity.

The larger the surface areaburned, the greater the dis-ruption of the skin’s ability toproperly maintain body tem-perature. The deeper a burngoes into the skin and under-lying tissue, the more likelythe risk of infection. Burnsinvolving the face, hands,genitals, and feet can resultin the limitation of basicfunctions, such as move-ment and sensation.

Breathing air at high temperaturescan create burns within the airwayand result in serious breathingdifficulty.

Minor Burns Minor burns include those thatinvolve the outer layer of the skin andresult in redness and pain. Theseinclude small burns that extend intothe deeper layers of the skin andcause some blistering.

Rapid first aid treatment for theseburns can provide immediate comfortand help prevent long-term complica-tions. Cool the burn with cool wateras soon as possible. Continue coolinguntil the pain is relieved. This willreduce pain, swelling, and the depthof injury. Do not apply ice directly tocool a burn.

Leave any blisters intact. Cover theburn with a loose sterile pad. Minorburns usually heal without furthertreatment.

Critical Burns Deep burns over a large area of thebody are the most severe. Theseburns often result in extensive blister-ing and destruction of skin tissue.

Make sure the situation is safe for youto help. If someone is on fire, tell himto stop, drop, and roll. Try to smotherthe flames with a coat, rug, or blan-ket, or douse him with water.

Activate EMS immediately. Exposethe affected area by cutting or tearingaway clothing. If any clothing is stuckto the burn, do not remove it. If pres-ent, remove any jewelry near theburned area.


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Burns


Separate fingers or toes withdry, sterile, non-adhesivedressings. Do not apply but-ter, ointment, lotion, or anti-septic. Loosely cover theburn area with a dry, cleanpad or clean sheet, if theburned area is large.

Give the person nothing toeat or drink. While awaitingEMS, monitor the airway forswelling from inhalation ofsmoke or hot gases.

Chemical BurnsSome chemicals can react and dam-age skin tissue on contact. Theimmediate care is to dilute andremove the chemical quickly to mini-mize the damage.

Brush off any dry powder with agloved hand or cloth. Remove anycontaminated clothing. Flood theaffected area with large amounts ofwater, unless the chemical is knownto react with water. Continue to flushwith water until the burning sensationstops.

Cover any visible burns loosely with adry, clean pad and seek further med-ical attention.

Electrical BurnsElectrical burns are causedby contact with electricalwires, current, or lightning.

Be safe! Turn the power offbefore touching the affectedperson. If you cannot make itsafe, do not attempt care.

Consider any fallen or broken wire extremelydangerous. Do not touch (or allow your clothing totouch) a wire, victim, or vehicle that is possiblyenergized. Do not approach within 8 feet of it. Notifythe local utility and have trained personnel sent toscene. NEVER attempt to handle wires yourselfunless you are properly trained and equipped.

CAUTION!

An electric shock can cause anabnormal heart rhythm in which theheart stops. If this occurs, activateEMS and have someone get an AEDif one is available. Perform CPR untilan AED is ready, another provider orEMS personnel take over, or you aretoo tired to continue.

If the person is responsive, thermalburns may be present at the placesthe current entered and exited thebody.

Internal injury from an electric shockis often more severe than might besuspected. Always seek professionalmedical care, since the extent ofinjury may not be apparent.

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Caring for Sudden Illness

Warning Signs of Sudden Illness

Medical conditions and illnesses can suddenly trigger an unexpected medicalemergency. Suspect a serious illness when, without warning, a person suddenlyappears weak, ill, or in severe pain.

In many cases, the human body displays warning signs to alert us to serious ill-ness. The most common warning signs of serious illness are:

� Altered mental status

� Breathing difficulty or shortness of breath

� Pain, severe pressure, or discomfort in the chest

� Severe abdominal pain


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Altered Mental Status

Caused by a number of medical conditions, an altered mental status is a sig-nificant or unusual change in a person’s personality, behavior, or consciousness.It is an indication of a change in brain function.

Regardless of the cause, an altered mental status is a warning sign of a seriousproblem and is considered a medical emergency.

Activate EMS. Position the person for comfort. Calm and reassure the person asbest you can.

If the person’s level ofresponsiveness is or be -comes severely diminished,consider placing the personin a recovery position to pro-tect the airway. Reassessregularly until another pro -vider or EMS personnel takeover.


Fainting is the result of a drop in blood flow to thebrain, usually due to a reaction to sudden stress,lack of food or water, or prolonged standing inplace. A person suddenly becomes lightheaded ordizzy and may collapse. In most cases, the effectsare temporary and not serious.

Lay the person flat. If there is no evidence of injury,raise the feet about 6 to 12 inches. If not possible,sit the person forward and place his head betweenhis knees. Keep the person still and quiet until heor she feels better.

Fainting

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StrokeA stroke, or brain attack, occurs when the blood supply to a portion of the brainis suddenly interrupted. This most commonly occurs when a blood clot getscaught in a blood vessel. A stroke can also occur when a weak spot in the wallof a blood vessel, known asan aneurysm, bursts openand bleeds into the sur-rounding brain tissue. In bothcases, brain cells die.

Signs of a stroke can vary.They tend to show upsuddenly.

� Numbness or weak-ness of the face, arm,or leg, especially onone side of the body,may be present.

� A person may appearconfused.

� A change in the ability to speak or understand can occur.

� Sight and balance can be affected, and,

� A severe, sudden headache may be described.

A stroke is a true medical emergency. Activate EMS immediately if a stroke issuspected. Rapid treatment in a hospital is critical to limiting the damage thatcan occur.

A person experiencing a stroke can become frustrated at being unable to moveor communicate clearly. The person may appear confused but still be aware ofwhat is happening. Calm, comfort, and reassure the person until another provideror EMS personnel take over. Do not give anything to eat or drink.

Whenever a stroke is sus-pected, be prepared for thepossibility of sudden car-diac arrest and the need forCPR and the use of an AED.

A quick method to determine if someone could besuffering from a stroke is to ask the person to:

� Smile� Hold up both arms� Speak a simple sentence

If the person has trouble with any of these tasks, astroke may have occurred.

Stroke Assessment

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Diabetic EmergenciesDiabetes is a disease inwhich the body cannot effec-tively use sugar for energy. Adiabetic emergency canoccur when the amount ofsugar in the blood becomesvery high or very low.

Suspect the possibility of adiabetic emergency withanyone who has a gradualchange in mental status. Theskin may be pale, cool, andsweaty. You may also noticea sweet or fruity smell in theperson’s breath.

If a person is diabetic, there may be evidence of the condition. Ask others aboutthe person’s medical history or medications he or she may be taking. Look for amedical alert bracelet or necklace identifying the condition.

If you know the person is diabetic, determine his or her level of response andability to swallow. If the person has a diminished level of responsiveness and hasdifficulty swallowing, activate EMS. Do not give anything to eat or drink.

If the person is responsive and able to swallow without difficulty, give sweet juice,candy, or any sweet substance containing sugar. If the person has oral glucosegel, use that instead. Do not use anything with an artificial sweetener.

Calm, comfort, and reassure the person. If he or she responds to the sugar, hisor her mental status will gradually improve. If there is no response to sugar withinabout 15 minutes or the condition worsens, activate EMS. Reassess regularlyuntil another provider or EMS personnel take over.

It is important to note that insulin is not considered an emergency medication. Itis never appropriate to administer insulin to a diabetic person in an emergencysetting.


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SeizureSeizures are triggered by excessive electrical activity within the brain. The resultis uncontrolled muscle convulsions throughout the body.

Generally, seizures happenwithout warning. Jerkingmovements of the bodyoccur and breathing mayseem absent. The personcan lose control of his or herbowel or bladder, and mayvomit.

While there are many thingsthat can cause a seizure tooccur, the care provided isalways the same. Protect theperson during the seizure.Move objects away that hemay bump in to. Do not restrain theperson. Allow the seizure to take itscourse.

Do not put anything in the mouth,including your finger. There is no dan-ger of the tongue being swallowed.

Activate EMS if the person:

� Is injured during the seizure

� Has no history of seizure

� Continues to seize for morethan 10 minutes

Most seizures last only a short time,and stop without any special treat-ment. If response and breathing areabsent after a seizure stops, beginCPR and get an AED if one is avail-able.

Once a seizure stops, it is normal forresponsiveness to improve slowlyover time. Provide continual reassur-ance as the person improves. Provideprivacy to minimize embarrassment.Continue to monitor until the personreturns to normal.


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Breathing Difficulty, Shortness of Breath

Breathing difficulty or shortness of breath is a medical emergency. It is generallycaused by an underlying medical illness such as asthma, allergic reaction, heartfailure, or lung disease.

At rest, normal breathing is regular and effortless. You may first suspect difficultywhen there is a noticeable increase in the effort required to breathe and the rateat which breaths are occurring. Unusual breathing sounds may occur. A bluish-purple tissue color, especially in the lips or fingers, indicates a developing lackof oxygen and is a serious sign.

Do not wait to see if a person's condition will improve. Activate EMS withoutdelay. If an AED is available, have someone get it. Allow the person to find themost comfortable position in which to breathe. Loosen any tight clothing. Calm,comfort, and reassure the person until another provider or EMS personnel takeover.

Breathing difficulty can quickly become life threatening as a person becomesexhausted from the breathing effort. Be prepared to provide CPR and attach anAED if the person’s condition worsens.


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Asthma

Asthma, or reactive airway disease, affects the small air passages in the lungs.Irritants can trigger a reaction that results in narrowed passages due to swellingand the production of mucus. Airflow into and out of the lungs is restricted.

Asthma symptoms can vary from mild to life threatening.

Quick relief medications that work fast to control asthma symptoms are available.If the person has a pre-scribed inhaler for asthma,assist her in using it. If theperson does not improvewithin 15–20 minutes, acti-vate EMS.



State laws and regulations may prescribe specificpractices, rules, and standards for assisting anotherperson with prescribed medication. Be aware of theregulations in your local area.

Assisting with Medication

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Severe Allergic Reaction

A severe allergic reaction, or anaphylaxis, is an extreme response of the body’simmune system to something it is very sensitive to. Common things that can ini-tiate a severe reaction include bee stings, peanuts, latex, and penicillin.

When anaphylaxis occurs, the airway becomes constricted due to swelling of thethroat, making it difficult to breath. Wheezing may be heard. Swelling of the lips,eyelids, and face may occur. Itchy raised lumps, or hives, can appear on the faceand chest. The person may complain of nausea and abdominal cramping.

A reaction can develop rapidly. In general, the faster the reaction occurs, the moresevere it is. Without treatment, death can occur within 15 minutes.iv

Activate EMS. Allow the person to find the most comfortable position in whichto breathe. Loosen any tight clothing. Calm, comfort, and reassure the person.

A person with a history of allergic reactions may carry a prescribed epinephrineauto-injector. Epinephrine can quickly reverse the effects of the reaction and maybe lifesaving. If the person has an auto-injector available, assist the person inusing it on himself.

Reassess regularly until another provider or EMS personnel take over.



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Pain, Severe Pressure, orDiscomfort in the Chest

Acute coronary syndrome, or ACS, occurs when there is reduced blood flowto the tissues of the heart. Often described as a heart attack, ACS is a seriouscondition that can result in significant damage to the heart.

Someone with ACS will generally experience pain, severe pressure, or discomfortin the chest. Women often do not experience these signs and will describe indi-gestion, weakness, or fatigue. Shortness of breath, nausea, and lightheadednesscan also occur. The person’s skin may be pale, cool, and sweaty.

A person who has had previous heart problems is at risk for recurrence. Ask theperson or any bystanders about prior problems or medications being taken.

Activate EMS immediately, even if the person does not want you to. If an AED isavailable, have someone get it and keep it nearby. Do not try to transport the per-son to a hospital yourself.

Allow the person to find the most comfortable position in which to breathe.


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Loosen tight clothing. Calm,comfort, and reassure theperson.

A person who is having aheart attack may deny it.This is a common occur-rence in ACS. Accept it, butnever let this alter yourapproach to care.

Someone with a heart condi-tion may carry a prescribedmedication known as nitro-glycerin. Assist the person intaking it.

Aspirin can be lifesaving for a personhaving a heart attack. While waitingfor EMS providers to arrive, encour-age the person to chew one non-coated adult (325 mg) or twolow-dose (81 mg) “baby” aspirin. Do

not encourage aspirin use if the per-son has an allergy to aspirin, evidenceof a stroke, or a recent bleeding prob-lem.

Whenever a heart attack is sus-pected, be prepared for the possibilityof sudden cardiac arrest, and the

need for CPR and the useof an AED. Continue toreassure the person untilanother provider or EMSpersonnel take over.

Heart disease, through heart attacks and strokes, isthe leading cause of death for men and women inthe United States. Statistics indicate more than onein four deaths was related to heart disease; half ofthe deaths were women.

A healthy lifestyle can lower the risk of heart disease:

� Follow a healthy diet to prevent or reducehigh blood pressure and high bloodcholesterol

� Maintain a healthy weight� Control alcohol intake� Don’t smoke� Exercise regularly

Heart Disease

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Severe Abdominal Pain

Severe abdominal pain can be a warning sign of serious illness, especially if itappears suddenly or is a new experience for the patient.

There are a number of important organs in the abdomen. Depending on the bodysystems involved, many serious problems can occur and cause pain. Early recog-nition and rapid transport to a hospital may help to prevent the development ofa life-threatening condition.

A person complaining of severe abdominal pain will typically try to find a positionof comfort to relieve the pain. The abdomen may be rigid and tender to the touch.The person may become nauseated and vomit. The person may describe a recentblunt blow to the abdomen or may be pregnant.

Activate EMS. Allow the person to find the most comfortable position possible.Reassure the person and keep her as calm as possible. Do not give anything toeat or drink. Reassess regularly until another provider or EMS personnel takeover.


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Poisoning

Ingested PoisoningAny substance that can enter the body and create a harmful disturbance orreaction in the body can be described as a poison.

By far, poisoning most oftenoccurs by ingestion. Childrenunder six years old accountfor over half of all poisonings.Most poisoning deaths inchildren are accidental, whilemost deaths in adults areintentional. Common in -gested poisons include painmedications, personal careproducts, and householdcleaning products.v

The effects of ingested poi-sons are wide-ranging andoften resemble those of common ill-nesses. Abdominal pain or cramping,nausea, and vomiting may occur. Aperson may also have an alteredmental status. Often, the ingestion isdescribed by the person. Open andempty containers, unusual smells,and odd staining on clothes, skin, orlips may be present.

If you suspect a person has ingestedsomething poisonous, act quickly.Activate EMS if the person is display-ing any serious signs or symptoms.Keep the person still. Calm, comfort,and reassure.

In the United States, calling theNational Poison Help Hotline at1-800-222-1222 automatically trans-fers you to a regional poison controlcenter. Poison centers can quickly pro-vide information regarding the imme-diate treatment of any substance.

You can help EMS providers and thepoison center by clearly identifyingthe substance and providing detailsabout the incident. Save any vomit,bottles, or containers for EMS.

Do not induce vomiting, or give water,milk, activated charcoal, or syrup ofipecac to the person unless you areadvised to do so by the poison con-trol center or EMS.

Reassess the person regularly untilanother provider or EMS personneltake over.


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Poisoning

Inhaled PoisoningInhaled poisoning occurswhen a harmful substanceis breathed in. Common in -haled poisons include car-bon monoxide from smokeor engine exhaust, naturalgas, solvent fumes, andchemical vapors.

A person may complain of aheadache, nausea, dizzi-ness, and difficulty breathing.An altered mental status canoccur. Suspect inhaled poi-soning whenever someone isworking in an enclosedspace and he or she is feel-ing ill.

Make sure it is safe for you tohelp. If you can do so with-out risk to yourself, immedi-ately move the person tofresh air. Allow the person tofind a comfortable position.

Activate EMS if the personis displaying any serioussigns or symptoms. Call theNational Poison Help Hot-line at 1-800-222-1222 foradditional directions on care.Help identify the substanceand provide details about theincident.

Reassess regularly untilanother provider or EMS per-sonnel take over.

Direct skin contact with plants such as poison oak,poison sumac, and poison ivy can cause problem-atic skin reactions. Usually occurring within hoursor days of exposure, these reactions result in itchy,red skin rashes with open sores.

If you have been exposed, you may be able to pre-vent a reaction by washing the affected area withsoap and water as soon as possible to remove theoily plant resin. Carefully handle and wash anyclothes or tools that may have been exposed.

If a minor reaction occurs, commercial relief prod-ucts are available to ease symptoms. Seek medicalattention if the reaction seems serious.

Poisonous Plants

The use, or overuse, of alcohol, drugs, or medica-tions can result in serious life-threatening problems.A diminished mental status can result in the loss ofan airway. Breathing can become depressed andstop. Vomiting can occur.

In quantity, these things can become toxic or poi-sonous and result in internal damage to bodyorgans and functions. Treat as with any othersuspected ingested poisoning. Call the NationalPoison Help Hotline at 1-800-222-1222 for treat-ment recommendations.

Alcohol, Drugs, and Medications


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Environmental Emergencies

Heat ExhaustionHeat-related problems occur when the body’s normal temperature-reducingmechanisms get overwhelmed, especially during vigorous physical activity, andbecome inefficient or stop working.

An active body creates heat.When it is exposed to hot,humid temperatures, sweat-ing occurs to evaporate andcool the body. Heat exhaus-tion can develop from thecombination of an increasedinternal temperature and theexcessive loss of fluids to theenvironment, typically fromsweating.

Signs include heavy sweat-ing and pale, cool skin. Theperson may become nause-ated and vomit. He or she may com-plain of a headache or dizziness, andfeel weak.

Although it may not appear serious,treat suspected heat exhaustion with-out delay. Without immediate treat-ment it could progress to heat stroke,a life-threatening condition.

Stop the person from theiractivity and move him or herto a cooler place. Loosen orremove excess clothing.Have the person lie downand raise the legs six totwelve inches. Spray wateror apply cool, wet cloths to

head and torso. Use a fan to speedevaporation.

Encourage the person to drink coolfluids, preferably a sports drink withcarbohydrates and electrolytes. If theperson does not improve or seems toget worse, activate EMS.


Heat cramps are uncontrollable muscle spasmsthat can affect the calves, arms, abdominal muscles,and back. They can occur suddenly and be verypainful.

Manage cramps by stopping activity, moving theperson to a cooler location, and drinking water or asports drink. Stretching and direct pressure to thecramping muscle may help. Delay further activityuntil the cramping has been resolved.

Heat Cramps

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Heat Stroke

Heat stroke is a true life-threatening medical emergency. It can occur due tooverexertion in a hot humid environment or as the result of a breakdown in thebody’s ability to shed heat. If body temperature rises significantly, it can quicklycause permanent damage to sensitive organs, including the brain and spinal cord.

In addition to the signs of heat exhaustion, a person with heat stroke will have analtered mental status. The skin can become red, very warm, or even hot, and becompletely dry. Heavy sweating could be present, especially when exertion is thecause. The person may collapse and have a seizure.

Activate EMS immediately. Begin aggressive cooling with the resources available.

Spray or pour water on the victim and fan him. Apply ice packs to the person’sneck, groin, and armpits. Cover the victim with a wet sheet and continue to fan.The best method, when possible, is to immerse the person in cool water up tohis neck.

If the person is unresponsive, place him on his side in the recovery position toprotect the airway. Do not force the person to drink fluids. Never give an unre-sponsive person anything by mouth.

Provide continuous cooling until EMS arrives. With early recognition and imme-diate cooling, the survival rate approaches 90%.vi


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Hypothermia, a generalizedcooling of the body, occurswhen the internal core bodytemperature has decreasedto 95° F or less. It is a life-threatening condition.

Body processes becomeimpaired and eventually fail.Cardiac arrest may occur. Tohelp recognize hypothermia,look for signs such as:

� Pale, cold skin

� Uncontrollableshivering

� Loss of coordination

� Difficulty speaking

� An altered mental status

Severe hypothermia can result in theloss of shivering and a slowing of thebreathing and heart rate.

To care for the person:

� Carefully and gently move himto a warmer place

� Remove wet clothing

� Cover the person with some-thing dry and warm

� Cover his head and neck toretain body heat

If available, activate EMS and get anAED if one is available. Be preparedto perform CPR and use the AED.


HypothermiaCold, wet temperatures can result in a lowering of the internal body temperature.Hypothermia and frostbite are the most dangerous cold-related conditions.

If you are far from professional med-ical care, begin actively rewarmingthe person. Place him near a heatsource. Put containers of warm, butnot hot, water in contact with the per-son’s skin.

It is best to recognize and treathypothermia early. The chance forsurvival decreases as the conditionprogresses.


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FrostbiteFrostbite develops when skin freezes. Body parts that are exposed to extremecold, such as fingers, toes, earlobes, cheeks, and nose, are the most likely to beaffected.

Early signs of developingfrostbite include a pins-and-needles sensation and throb-bing. Later signs include aloss of feeling in the affectedpart and firm, pale, cold,numb skin.

Minor frostbite can betreated with simple rewarm-ing using skin-to-skin con-tact, such as a warm hand.

If more serious, quickly getthe person to a warmerplace. Remove wet clothing.If available, activate EMS.

When EMS is available, or there is any chance that the part may refreeze, do nottry to rewarm the frostbitten area.

Remove any jewelry from the affected areas. Place clean pads between frostbittenfingers and toes. Wrap the affected part with a clean towel or pad. Do not rub ormassage the affected area or disturb blisters on frostbitten skin. Never give thevictim alcoholic beverages. They do not help and may be harmful.

Calm, comfort, and reassure the person until EMS providers arrive.

If you are far from professional medical care, and there is no chance refreezingwill occur, rewarm the affected part yourself.

Immerse the frostbitten area in warm water for 20–30 minutes. The water shouldbe warm, not hot — just above normal body temperature. Check and maintainthe water temperature often. Severe burning pain, swelling, blistering, and colorchanges may occur.

Do not use chemical warmers directly on frostbitten tissue because they cancause burns. Do not let the person use the affected part after it is thawed. Getthe person to professional medical care as soon as you are able to.


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Additional Considerations

Emergency Moves

It is best not to move an ill or injured person unless he or she is clearly endan-gered or requires life-supporting care. The greatest concern in moving a seriouslyinjured person is the chance of making a spinal injury worse.

If you decide it is necessary to move someone, the most effective move to use isa drag. When using a drag, pull in the direction of the long axis of the body to keepthe spine in line. Never pull on a person’s head or pull their body sideways.

Common drags include the extremity drag, performed by grasping and pullingon the ankles or forearms; the clothing drag, performed by pulling on a person’sshirt in the neck and shoulder area; and the blanket drag, performed by rolling aperson onto a blanket and dragging the blanket.

When moving someone, use your legs, not your back, and keep the person asclose to your body as possible. Avoid twisting. Consider the person’s weight.Know your physical ability and respect your limitations.

Vehicle fires in traffic crashes are relatively rare. Bystanders have dragged injuredpeople from vehicles in the mistaken belief that the vehicle will catch fire andexplode. Moving a person when it is not necessary can make injuries worse.Avoid moving an injured person from a damaged vehicle unless you believe hisor her life is clearly in danger.


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Additional Considerations


Emotional ConsiderationsCaring for someone in an emergency can create emotional distress. More seri-ous problems or relationships with those involved can intensify these feelings.Common reactions include:

� Anxiety

� Trembling or shaking

� Sweating

� Nausea

� Fast breathing

� Pounding heartbeat

This is a normal human reac-tion to a traumatic event.Simply remember to staycalm and accept your limita-tions as a provider.

When an emergency is over,a provider is often left alone while anill or injured person is transportedaway by EMS. With little time for clo-sure, you can begin to experience avariety of reactions. These include:

� Feeling abandoned or helpless

� Recalling the event over andover

� Self-doubt about not doingenough

� Difficulty concentrating

� Heaviness in the chest

� Upset stomach or diarrhea

� Difficulty sleeping or nightmares

It is important to understand thatthese feelings are normal and shouldpass with time. However, there areactions you can take to help copewith and work through the difficulty.

Informally speak to someone youtrust to listen without judgment, suchas a family member, friend, orcoworker. Get back to a normal rou-tine as soon as possible. Accept thatit will take time to resolve theseemotions.

If unpleasant feelings persist, formalassistance from a professional coun-selor may be helpful as you workthrough your emotions about theevent.

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Caring for Specific First Aid ProblemsYour training so far has focused on the recognition and general treatment forthe most serious medical problems that can occur. Early bystander first aid careis an important factor in improving survival and recovery from these problems.

In comparison, bystander care is not as critical in the detailed treatment of spe-cific problems, especially when an effective EMS system is in place.

However, first aid providers in locations with longer EMS response times or envi-ronments that pose a higher risk of specific medical problems may benefit fromadditional training.

Depending on your situation, your Instructor may elect to cover one or more ofthe following specific first aid problems in class. If not, they are included on thefollowing pages for your later review.

Specific First Aid Topics


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Amputation

Amputation is the complete loss of a body part. If an amputation has occurred,quickly assess for and control any severe bleeding. Activate EMS. Calm, comfortand reassure the person. Treat for shock.

Amputated body parts can often be surgically reattached. Once the person isstable, locate the severed part. Wrap it in a sterile or clean cloth. Place the partin a tightly sealed plastic bag or waterproof container. Place the bag or containeron ice.

Do not soak the severed part in water, and do not put it directly on ice. Give it toEMS providers for transport with the person to the hospital.


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Impaled Object

An impaled object is anobject that penetrates abody part and remainsembedded.

As a general rule, neverremove an impaled object. Itcan act like a plug and pre-vent serious blood loss. Animpaled object can also beembedded into body struc-tures below the skin. Move-ment of the object, or thebody part it is in, could cre-ate additional injury.

If you suspect impalement has occurred, remove or cut away clothing to confirmthe object has penetrated the skin. Look for any serious bleeding.

Keep the person still to prevent movement. Activate EMS for any significantimpaled object or if you are in doubt about its severity. If the injury is bleeding,use a clean pad to applydirect pressure around thebase of the object to controlit. Use additional padding tostabilize the object.

If needed, support the per-son’s weight to relieve pres-sure on the object. Usepadding to provide stabilityand comfort.

Reassure the person to keephim or her calm. Treat forshock. Reassess the personand the injury regularly untilEMS arrives.

Splinters are small, sharp pieces of foreign materialthat become embedded in the skin. They need tobe removed to keep a wound from becoming in-flamed or infected.

Most splinters can be easily treated. If there is aprotruding end, use tweezers to grab the splinterand pull it out in the direction it entered. If the endof the splinter is not protruding, use a small needleto loosen the skin around it. Once you can graspthe splinter with tweezers, pull it out in the directionit entered.

If a splinter is deeply embedded or you have onlybeen able to remove a piece of it, seek professionalmedical care.

Splinter

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Open Chest Injury

Expansion of the chest during breathing causes suction, which pulls outside aircontaining oxygen through the airway and into the lungs. A puncture injurythrough the chest wall can disrupt this ability to draw air into the lungs.

If you suspect an injury has penetrated the chest wall, remove clothing to exposethe injury site. Check to see if there is an exit injury on the other side of the chest.If there are two wounds, treat the more serious one first.

Air movement through the wound can be indicated by foamy, bloody air bubbles.You may hear a sucking sound. Quickly cover the wound with something airtight.You can start with a gloved hand. Activate EMS.

Consider covering the wound with an airtight dressing using material such asplastic wrap or aluminum foil. The covering should be wide enough to extend twoinches or more past the edges of the wound in all directions. If tape is available,tape three sides of the covering to the chest wall. Leave one corner of the materialun-taped. This will allow trapped air to escape.

If possible, allow the person to assume a position he or she is most comfortablein. Treat for shock. Regularly assess the person and the injury until EMS arrives.


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Open Abdominal Injury

Injury to the abdomen may result in a condition known as evisceration, in whichabdominal organs protrude through an open wound. It is important to understandthat these are functioning organs and the primary treatment is to protect themfrom further injury.

If an open injury through the abdomen has occurred, activate EMS. Cover anyprotruding organs with a thick, moist dressing. Do not push the organs backinside the body.

Do not apply direct pressure on the wound or exposed internal parts, as this couldcause further injury. Treat for shock. Regularly assess the person and the injuryuntil EMS personnel arrive.


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Impaled Object in the Eye

Objects that penetrate the surface of the eye require immediate professionalmedical care. Foreign bodies propelled at high speed present the highest risk.vii

Activate EMS. Immediate carerequires stabilization of theobject and reducing additionalinjury. Do not allow the personto rub the eye. Never try toremove an embedded object.

For small objects, cover botheyes with loose pads. Eyesmove together. Covering botheyes prevents movement of theaffected eye.

Stabilize larger objects with abulky, clean pad. Cover theuninjured eye with a loose pad.

Covering both eyes can befrightening. Stay with the person and calm, comfort, and reassure him or her tohelp reduce anxiety. Regularly assess the person until EMS arrives.


Small foreign objects on the surface of an eyewill cause irritation and discomfort.

Encourage the person not to rub the affectedeye. Have the person blink several times to seeif the eyelid or tearing can remove the objectnaturally. If not, flush the eye with tap water orsaline eyewash solution. Flush outward from thenose side of the eye.

If pain continues or the person feels likesomething is still in the eye, cover the eye lightlywith a gauze pad and seek professional medicalcare. If the person has been exposed to flyingmetal fragments (hammering, grinding, etc.), donot attempt re moval. Seek professional medicalcare immediately.

Irritated Eyes

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Chemicals in the Eye

Corrosive chemicals splashed into an eye can quickly damage eye tissue.

Getting a corrosive chemical in the eye is painful. Affected eyes will appear redand watery.

To minimize damage, immediately flood the eye with large amounts of water. Holdthe eye open and flush continuously for at least 15–30 minutes. Flush outwardfrom the nose side of the affected eye to prevent contamination of the unaffectedeye.

If the person is wearing contact lenses and the lenses did not flush out from therunning water, have the person try to remove the contacts after the flushing pro-cedure.

Chemical burns to the eye require professional medical care. Activate EMS asquickly as possible.

In factories, laboratories, and other occupational settings where there is a knownor increased risk for chemical eye burns, specialized therapeutic rinsing solutionsthat have been properly tested and approved may be available. Follow the estab-lished policy and manufacturer’s directions for use.


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Nosebleed

Nosebleeds can occur when small blood vessels inside the nostrils are rup-tured. Most nosebleeds are not serious and can be easily handled. Rarely doesa nosebleed become life threatening.

To care for someone with a nosebleed, have the person sit up straight with hisor her head tilted forward, chin down. Pinch the nose with your thumb and indexfinger and hold it for about 10 minutes.

Do not tilt the head back or have the person lie down. These actions may causehim or her to swallow blood and vomit. Have the person spit out any blood thatcollects in his or her mouth.

If you cannot stop the bleeding, seek immediate medical attention.


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Injured Tooth

A physical blow to the mouth can break, dislocate, or knock out teeth.

Control any bleeding. Have the person gently bite down on an absorbent pad.The application of ice may help to reduce bleeding, swelling, and pain. If the toothis still in place, get the person to a dentist without delay.

If the tooth has been knocked out, early care can increase the chance that a per-manent tooth can be successfully re-implanted. Handle the tooth only by thechewing surface, called the crown. Do not touch the root, the part of the tooththat embeds in the gum.

Gently rinse the tooth with water if it is dirty. Never scrub the tooth or remove anyattached tissue fragments. If possible, place the tooth back in the tooth socket.If not, keep the tooth moist. Have the person spit into a cup and place the toothin the saliva. Milk, contact lens solutions, or commercial sports drinks can alsobe used. Avoid using water.

Get the person to a dentist as quickly as possible, preferably within 30 minutes.The faster you act, the better the chance of saving the tooth.


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Pregnancy Complications

Vaginal bleeding may occur during pregnancy. Light, irregular discharges ofblood, or spotting, is normal. However, significant bleeding, especially late in thepregnancy, indicates a more serious problem may be occurring.

Severe abdominal cramping and pain can occur. Her skin may be cool, clammyto the touch, and pale in color. She may be weak and lightheaded.

Activate EMS immediately. Help her lay down on her left side. When lying faceup, the baby puts pressure on a major vein that returns blood to the heart. Layingthe mother on her left side improves blood flow to the mother and baby.

Have her place a sanitary pad over the vaginal opening. Do not have her insertanything inside the vagina. Treat for shock. Maintain a normal body temperature.Insulate on top and underneath to prevent heat loss. Calm, comfort, and reassureher. Do not give her anything to eat or drink.

Reassess regularly until another provider or EMS personnel take over.


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Bites and Stings

Bites and stings can occur from a wide variety of insects, reptiles, animals, andeven humans. Most are not serious and cause only minor swelling, redness, pain,and itching.

In general, care for bites and stings by washing the site with soap and water. Asa precaution, always remove jewelry from the affected area. Apply an antibioticointment and cover the area with an adhesive bandage or a pad. Except forsnakebites, use local cooling to reduce swelling and pain.

Some bites and stings are more serious and can benefit from first aid care. Thisis especially true for individuals who are very young or old, or have existing med-ical issues. Venomous bites and stings inject venom, or poison, into the body.Focus on slowing the absorption of venom into the body and quickly activatingthe EMS system for specialized treatment.


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SnakebitesPit VipersVenomous pit vipers, suchas cottonmouths, copper-heads, and rattlesnakesstrike once and leave a char-acteristic bite with single ordouble fang marks. Pit viperbites can cause an intense,burning pain and local swell -ing. Swelling may involve theentire limb within hours.

If you suspect a pit viperbite, have the person sit stilland activate EMS. Control any bleeding with a clean pad and direct pressure.Immobilize the injured part and keep it below heart level.

Coral SnakeA venomous coral snake biteis different than one from apit viper. Coral snakes“chew” with fixed fangs. Painand swelling at the bite sitemay be minimal or absent.Serious effects are oftendelayed and can includeabdominal pain, nausea andvomiting, rapid heartbeat,difficulty breathing, drooling,and an altered mental state.

If you suspect a coral snake bite, activate EMS and have the person sit still. Toslow venom spread, apply a pressure bandage around the entire length of thebitten extremity. Wrap towards the body. The bandage should be snug, but notso tight that you can’t slip a finger under it. Immobilize the injured part and keepit below heart level.

With all snakebites, keep the person warm, reassured, and quiet. Move the per-son only if needed.

When caring for a snakebite, do not apply local cooling. Do not cut through asnakebite wound, apply suctioning, or use a tourniquet. These treatments are noteffective and may be harmful.

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Spider BitesSpiders typically inhabit outof the way places such aswood piles or outbuildings.There are certain spidersthat can be dangerous tohumans. This includes theblack widow and the brownrecluse.

Initially, venomous spiderbites are often difficultto identify. Small puncturemarks and bleeding may beseen. Tenderness, swelling,pain, itchiness, and redness at the bite site can develop. Over time, crampingpain and muscular rigidity in the body may occur. A person may experience fever,weakness, nausea and vomiting, or difficulty breathing.

If you suspect a severe reac-tion from a spider bite maybe occurring, activate EMS.Keep the person warm, reas-sured, and quiet.


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Stinging Insects

Stinging insects such as bees, wasps, and fire ants are normally passive exceptwhen in defense of their nests or territories. While wasps and fire ants can stingrepeatedly, the stinger of a honey bee detaches from its body, remains embeddedin the skin, and continues to inject venom. If a stinger is present in the skin,quickly remove it.

It is possible for a life-threatening allergic reaction to arise. Monitor the personfor at least 30 minutes to see if her condition worsens. If you suspect a severereaction is occurring, activate EMS without delay. If the person carries aprescribed epinephrine auto-injector, assist the person with using it.


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Tick Bites

Ticks are blood-feeding insects that are typically found in tall grass and shrubs.The biggest concern with tick bites is the exposure and transmission of infectiousdisease.

When a tick bites, it attaches itself firmly to the skin. To remove it, grasp it closeto the skin with tweezers or a tick removal tool. Pull straight up with a steady,slow motion. If portions of the tick remain in the skin, seek further medicalattention.

Do not use fingernail polish, petroleum jelly, a glowing hot match, or alcohol toremove a tick. These actions have no proven value and may cause additionalproblems.


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Marine Animal Stings

Stings from marine animals such as fire coral, sea anemones, and jellyfish canoccur when swimming or diving in the ocean. Stings can result in significant painat the sting site and a raised, red, itchy rash.

Wash the sting site with household vinegar as soon as you are able to for at leastthirty seconds to deactivate the venom and prevent further stinging. To helpreduce pain, shower or immerse the sting site with hot water for at least 20 min-utes or until the pain subsides. The water should be as hot as the person cansafely tolerate.

Stingrays can also be encountered in the ocean. A stingray punctures the skinwith a barb to inject venom. Intense pain can occur at the sting site. Immerse theinjured area in water as hot as the person can tolerate for 30–90 minutes to deac-tivate the venom and help relieve pain.viii Carefully clean out the wound site.

Severe reactions to marine animal stings can include difficulty breathing, heartpalpitations, weakness, and fainting. If this occurs, activate EMS immediately.


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Human and Animal Bites

Human and animal bites can cause significant injury and bacterial infection. Bitesfrom animals such as raccoons, skunks, bats, and foxes can also cause rabies.Left untreated, rabies is fatal.

Control any bleeding with direct pressure. Wash the bite and flush with largeamounts of water. Seek professional medical attention.


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ReferencesThe MEDIC First Aid BasicPlus Student Guide is based upon the following standards,guidelines, and recommendations:

� “2010 International Consensus on Cardiopulmonary Resuscitation and EmergencyCardiovascular Care Science with Treatment Recommendations.” Circulation 122,suppl. 2 (2010): S250-S581.

� “2010 American Heart Association and American Red Cross International Consen-sus on First Aid Science with Treatment Recommendations.” Circulation 122,suppl. 2 (2010): S582-S605.

� “2010 American Heart Association Guidelines for Cardiopulmonary Resuscitationand Emergency Cardiovascular Care Science.” Circulation 122, suppl. 3 (2010):S639-S946.

� “2010 American Heart Association and American Red Cross Guidelines for FirstAid.” Circulation 122, suppl. 3 (2010): S934-S946.

� ANSI Standard Z490.1. “Criteria for Accepted Practices in Safety, Health, andEnvironmental Training.” American National Standard, 2009.

� ASTM Standard F2171-02. “Standard Guide for Defining the Performance of FirstAid Providers in Occupational Settings.” ASTM International, 2009.

� OSHA 3317-06N. “Best Practices Guide: Fundamentals of a Workplace First-AidProgram.” U.S. Department of Labor, Occupational Safety and Health Administra-tion, 2006.

� Other recommendations or sources as referenced by endnotes.

End Notesi. Takala, J. “Introductory Report: Decent Work — Safe Work.” International Labour

Organization, 2005. http://www.ilo.org/public/libdoc/ilo/2005/105B09_281_engl.pdfii. Centers for Disease Control and Prevention. “Traumatic Occupational Injuries.” The

National Institute for Occupational Safety and Health (NIOSH).http://www.cdc.gov/niosh/injury/

iii. “Unintentional Home Injury in the United States.” Home Safety Council.http://www.homesafetycouncil.org/AboutUs/Research/re_sohs_w013.asp

iv. Dugdale, David C. III. “Allergic Reactions.” Medline Plus: A Service of the U.S.National Library of Medicine. http://www.nlm.nih.gov/ medlineplus/ ency/ article/000005.htm

v. “National Poison Data System.” American Association of Poison Control Centers.http://www.aapcc.org/dnn/NPDSPoisonData.aspx

vi. Helman, Robert S., and Rania Habal. “Heatstroke.” Medscape Reference, 2010.http://emedicine.medscape.com/article/166320-overview

vii. Heller, Jacob L. “Eye Emergencies.” Medline Plus: A Service of the U.S. NationalLibrary of Medicine. http://www.nlm.nih.gov/medlineplus/ency/article/000054.htm

viii. DuBois, David. “Stingray Injury.” eMedicineHealth.http://www.emedicinehealth.com/ stingray_injury/article_em.htm

References and End Notes

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Glossary


GlossaryAbdominal Thrust

Thrusts administered to the abdomenof a responsive, choking person to forceair in the lungs to dislodge an objectblocking a person’s airway.

Acute Coronary Syndrome (ACS)Often described as a heart attack, ACSoccurs when there is reduced bloodflow to the tissues of the heart.

AirwayThe passageway between mouth andlungs that allows life-sustaining oxygeninto the body.

Altered Mental StatusA significant change in a person’s per-sonality, behavior, or consciousness,which may indicate a serious medicalproblem.

AmputationA complete loss of a body part.

AnaphylaxisA severe allergic reaction with an extremeresponse of the body’s immune systemto something it is very sensitive to.

Arterial BleedingA wound to an artery, which is charac-terized by bright-red, oxygen-rich bloodspurting from the wound.

AssessmentChecking for immediate, life-threateningproblems.

AsthmaReactive airway disease, affecting thesmall air passages in the lungs.

Automated External Defibrillator (AED)A portable, computerized device thatautomatically analyzes for life-threateningheart rhythms and provides correctivetreatment through adhesive pads on aperson’s chest. Most AEDs have spe-

cially designed pads or mechanismsavailable that reduce the defibrillationenergy to a level more appropriate for asmaller body size.

Bloodborne PathogensPotentially infectious body fluids.

BystanderSomeone who is present but not takingpart in a situation or event.

Cardiopulmonary Resuscitation (CPR)A combination of rescue breaths andchest compressions performed on aperson experiencing cardiac arrest, in-tended to restore some oxygen to thebrain.

Chain of SurvivalA concept of five interdependent links(early access to EMS, early CPR, rapiddefibrillation, effective advanced care,and integrated post-cardiac care) thatdescribe the most effective approachfor treating sudden cardiac arrest.

Chest CompressionPressing down on a person’s chest in arhythmic motion to increase pressureinside the chest and directly compressthe heart to keep blood circulating tothe brain and other internal organs.

Chest ThrustThrusts administered on the breastboneof a responsive, choking person to forceair in the lungs to dislodge an objectstuck in the person’s airway.

Compression-Only CPRAn alternative to conventional (com-pressions and rescue breaths) CPR inwhich the immediate use of ongoingchest compressions are provided for aperson who has suddenly collapsedand is unresponsive and not breathing(or breathing inadequately).

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CPR MaskA protective barrier device used to pre-vent contact with potentially infectiousbody fluids while performing rescuebreaths on a person. The mask fits overthe mouth and nose of the person andincludes a breathing valve for the firstaid provider to safely administer rescuebreaths.

CPR ShieldA protective barrier device used to pre-vent contact with potentially infectiousbody fluids while performing rescuebreaths on a person. The shield consistsof a flat square of malleable plastic witheither a hard-plastic breathing valve ora filter.

DefibrillationThe process of passing an electricalshock through the heart to restore anormal pumping rhythm.

DiabetesA disease in which the body cannot ef-fectively use sugar for energy, whichcan lead to life-threatening problems ifnot managed properly. A diabetic emer-gency is often characterized by an al-tered mental status.

Direct PressureThe act of applying pressure directlyon an open wound to help slow bleed-ing.

DislocationThe separation of bone ends at a joint.

DOTSAcronym used to help with physicalassessment: Deformities, Open injuries,Tenderness, Swelling.

Emergency Action Plan (EAP)A site-specific plan for workplace orhome that contains specific procedureson how to respond to internal emer-gencies and activate EMS.

Emergency Medical Services (EMS)The emergency medical response sys-tem developed within your community,typically using a specialized emergencycommunication network to gather in-formation and dispatch appropriateemergency resources. A first aid providercan activate EMS in an emergency,usually by calling an emergency num-ber.

Epinephrine Auto-InjectorA physician-prescribed, spring-loadedneedle that rapidly administers a meas-ured, single dose of epinephrine for se-vere allergic reaction.

EviscerationAbdominal organs protrude through anopen wound resulting from injury to theabdomen.

FractureBreaks in bone.

FrostbiteDevelops when body parts are exposedto extreme cold and skin freezes.

Good Samaritan LawA law enacted in all states to legallyprotect trained providers who voluntarilystop to help, act prudently, do not pro-vide care beyond training, and are notcompletely careless in delivering emer-gency care.

Head-tilt, Chin-liftA technique intended to open the per-son’s airway, involving tilting the person’shead back and lifting the person’s chin.Technique results in the base of thetongue lifting away from the back ofthe throat.

Heart AttackReduced blood flow to the tissues ofthe heart, also known as acute coronarysyndrome (ACS). It is usually charac-terized by pain, severe pressure, or dis-comfort in the chest.

Glossary


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Glossary


HypothermiaA generalized cooling of the body thatis a life-threatening condition, occurringwhen the internal core body temperaturehas decreased to 95° F or less.

Impaled ObjectAn object that penetrates a body partand remains embedded.

Implied ConsentA legal concept referring to the legitimateassumption that an unresponsive personwould give permission to be helped ifresponsive.

Internal BleedingA condition in which an injury causesbleeding inside the body, which can bedifficult to detect. Though the skin isintact, blood vessels have broken andare leaking blood into the body tissues.If the injury is substantial enough and itgoes untreated, it can lead to shockand become a potentially life-threateningproblem.

Mechanism of InjuryThe process by which external forceresults in injury.

NebulizerA device that uses compressed air toturn liquid medicine into a mist forinhaling.

Pacemaker orAutomated Internal Defibrillator

A surgically implanted device, whichmay be noticeable by a lump or surgicalscar.

Protective BarrierAnything that helps reduce the risk ofexposure to potentially infectious bodyfluids. Some examples of effective pro-tective barriers include latex (or non-la-tex) gloves, and ventilation shields andmasks.

Recovery PositionThe position in which an unresponsivebreathing person is placed to drainfluids from the mouth and keep thetongue from blocking the airway; placethe person on his or her side with headslightly forward.

Rescue BreathsArtificial breaths given to someone whois not breathing; administered by blowingair into the mouth to inflate the lungs.

SAMPLEAcronym used to help providers re-member what to ask a person about:Symptoms, Allergies, Medications, Pastmedical history, Last oral intake, Eventsleading to problem.

Secondary AssessmentFollows a primary assessment thatindicates no life-threatening problems,to gather additional information aboutthe person’s chief complaint, what hap-pened, and medical conditions.

SeizureTriggered by excessive electrical activitywithin the brain, which leads to jerkingmovements of the body, also calledconvulsions.

ShockDevelops when poor blood flow createsa shortage of oxygen to body tissues.Any serious illness or injury has the po-tential to cause it; if not treated early, itcan get worse and become life threat-ening. It can be characterized by di-minished responsiveness and skin thatis pale, cool, and sweaty.

Spinal Motion RestrictionManual stabilization of the head by cup-ping the hands on both sides of thehead without covering the ears; minimizeany motion of head, neck, and back.

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SplintStabilizing an injured limb to reducepain and prevent further injury, onlywhen there is an extended EMS re-sponse time or a need to move the in-jured person.

SprainsTearing injuries to ligaments that holdjoins together.

StrainsStretching or tearing injuries to musclesor tendons.

StrokeOccurs when the blood supply to aportion of the brain is suddenly inter-rupted. Commonly occurs when a bloodclot gets caught in a blood vessel. Inmost cases, brain cells die. Signs caninclude numbness of face, arm, or leg,especially on one side of the body;confusion; change in the ability to speakor understand; change in sight and bal-ance; and severe, sudden headache.

Sudden Cardiac ArrestOccurs when the normal electrical im-pulses in the heart unexpectedly becomedisorganized; the normally coordinatedmechanical contraction of the heartmuscle is lost, and a chaotic, quiveringcondition known as ventricular defibril-lation can occur. Blood flow to the brainand body stops abruptly. It ischaracterized by a stoppage of breath-ing, sudden collapse, and loss ofconsciousness.

Trained ProviderSomeone who is trained in the deliveryof CPR and use of an AED, until per-sonnel are available to provide moreadvanced care. The trained provider isoften the first emergency care giver onthe scene and plays a critical role insurvival.

TourniquetApplied to a limb with heavy bleedingwhen direct pressure is not possible ornot effective at controlling bleeding.

Universal PrecautionsAn approach that recommends handlingall blood and other body substancesas if they are infectious. To be effective,use protective barriers between yourselfand an ill or injured person, regardlessof relationship or age.

UnresponsiveA condition in which the person is un-conscious and does not regain con-sciousness when addressed or tappedby the trained first aid provider.

Ventricular FibrillationA chaotic, quivering heart rhythm thatinterferes with the heart’s ability to pumpblood.

Glossary


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BasicPlus CPR, AED, and First Aid for Adults


Rate Your Program Class Evaluation

Instructions: Please rate class instruction as indicated below. Evaluation ratingsand comments are used to improve our instructional techniques and materials. Anyinformation you give us is confidential. Thank you for your help.

Class InformationInstructor ________________________________________ Date of Class __________________

Type of class: 3 Initial 3 Renewal

Class InstructionUse this key to rate the items below:

5–Excellent, 4–Very Good, 3–Good, 2–Fair, 1–Poor

5 4 3 2 1

First Aid Provider 3 3 3 3 3

CPR 3 3 3 3 3

Defibrillation 3 3 3 3 3

Choking 3 3 3 3 3

Caring for injury 3 3 3 3 3

Caring for Sudden 3 3 3 3 3Illness

Additional QuestionsDid you watch theprogram video? 3 Yes 3 No

Was your class conducted in a relaxed, positive manner? 3 Yes 3 No

Do you feel a sufficient amount of time was spentdoing hands-on skill practice?

3 Yes 3 No

Self AssessmentUse this key to rate the items below:


How would you rate your emergency careskills BEFORE taking the MEDIC FIRST AID®

BasicPlus class? 5 4 3 2 13 3 3 3 3

How would you rate your emergency careskills AFTER taking the MEDIC FIRST AID®

BasicPlus class? 5 4 3 2 13 3 3 3 3

Course MaterialsUse this key to rate the items below:


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Student Guide 3 3 3 3 3

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