ATLANTIAN BUSINESS SOLUTIONS

FIRST PERSON ON THE SCENE

F-POS

BASIC 10 Hours OF TRAINING

INTERMEDIATE 30 Hours OF TRAINING

Pre – Hospital EnvironmentDefinition: Pre – Hospital CareAny Medical Intervention or procedure given prior to arrival of the casualty in HospitalDefinition: First Aid The First intervention of any person providing care to a person who has become ill through injury or illness (Including Mental Health)Definition: ParamedicAuthorised person trained to provide Advanced Medical Intervention outside of a Hospital Environment (including the administration of some authorised Drugs) Definition: Hospital CareAny Medical intervention given within a Hospital environment (NHS Trust) which could be Out-Patients, In-Patients, Doctors Surgery or Out Reach Clinics (Hospitals provide Advanced Specialist Medical Treatment)

Role of the First Person On the Scene• To Help reduce the amount of Unnecessary

deaths and complications by providing Medical Assistance prior to the arrival of Paramedics, Doctors or the Evacuation to Hospital facility

• Provision of the - CHAIN OF SURVIVAL

EARLY EMERGENCY SERVICE ACCESS

EARLY BASIC LIFE SUPPORT

EARLY DEFIBRILLATION

EARLY ADVANCED LIFE SUPPORT

Role of the First Person On the Scene

Scene Safety

Danger

Look

Listen

Think

Violence

DANGERS• Before undertaking any Patient Assessment• Consider your own SAFETY• Consider Safety at the SCENE• Consider SAFETY - PATIENT • Consider the stability of the ENVIRONMENT

The first few seconds of an incident will be confusing and dangerous for you or others

Don’t become a Casualty yourself

Or

Endanger Others Lives

LOOK• Immediate dangers to yourself, patients and others

(Drivers, The Public & Bystanders)

• Hazards – Electricity, Water, Land Slides, Violence, Chemicals, The Environment, Vehicles and Gases

• Incident – What has happened and what is about to happen

• Mechanism of Injury – Fall from Height, RTC, Sharps Injury, Act of Violence, High/Low speed impact & Velocity

• Position of Patient - Trapped, Lying Awkwardly, In Water, In Car, In between moving machines

• How Many Patients: Is anyone missing, What are their Injuries

• Triage injured C - ABC• What Assistance is already on the Scene

(Police, Fire or other Trained Medic’s)

Listen• Use your ears – Traffic, Creaking Buildings, Wind,

even for the lack of noise, it all tells a story• Listen to what bystanders or Witnesses telling

you about How, when, where, who and any other possible dangers or injuries

• Listen to Colleagues, Members of other Services

THINK

• Think and Consider all you have Seen• All you have heard• Your Priorities • What can be done to help the Patients• What Additional YOU need• What was the cause of the initial injuries

DON’T RUSH IN

TAKE A MOMENT TO ASSESS THE SITUATION

VIOLENCE

• Unfortunately people can turn violent even when being treated by Medical Staff

• Where always remain Calm yet Assertive• Be Polite and Professional• Maintain a clear exit route whenever possible• If the Aggression becomes focused on you Leave

immediately Contact your Supervisor/Police if in attendance

• Use Conflict Management Skills – Rapport, Empathy and engagement to reduce the chain of frustration (Frustration – Anger – Aggression – Violence)

Minimising the Risk of InfectionUniversal Precautions • Keep Cuts & Grazes Covered at all times• Good Personal Hygiene (Regular Hand Washing)• Clean , Short finger nails • Wash hands Before, After and in between medical interventions

or patient contacts• Wear PPE – Gloves, Eye Protection & Overalls• Dispose of Clinical Waste Appropriately (Such as bandages,

Sharps and used equipment)• All re-usable Equipment must be sent for disinfecting and

cleaning• Get Your immunisations up to date Tetanus & Hepatitis B

(Minimum) • Wash all stained clothing at 60 degrees centigrade

and separate from normal washes

Blood & Body Fluids - Spillages• These are a potential Hazard from Infection and

may contaminate other equipment• Deal with caution – Gloves – Face Mask Etc.• Ensure their Safe Removal• Minimise the Risk of Infection to YOU & Others• Small amounts of fluids may be wiped up with

paper towels or similar (Dispose in Clinical Waste bags)

• If in Possession of Granules, absorbent powder, Verucidal disinfectant spray - use as per manufacturers instructions

ALWAYS WEAR GLOVES WHEN DEALING WITH SPILLAGES

RESPONDING TO A CALLPLANNING IS ESSENTIAL :• Check: Mobiles, Pagers, Radios are Serviceable (Check for areas with poor reception on with your provider. Charged?)

• Check all Medical Equipment (Spare Batteries, Inspected/Calibrated, Straps not worn, In Date, Clinically Sealed etc.)

• Route Planning (Maps, Sat Nav, Weather, Accessibility & timings to RV points/Other Services, Vehicles)

• Paper Trail (Medical Notes, Roma’s, Patient Forms, Incident Reports) *If it’s not written down it didn’t happen or it’s your fault*

• Unless escorted you have NO EXEMPTION under the Road Traffic Act – Road Safety, Park Safely, light up the area – STAY ALIVE

EQUIPMENT – CHECKS (Demo)

• Personal Protective Equipment• Identity Cards• Gloves• Protective Overalls• Jackets• Torch• Pager• Pocket Mask• Scissors/Cutting Shears• AED – (Charged)• Various Dressings • Radio/Mobile Phones• Maps • Patient Report Forms

• Stiff Neck Collars (All Sizes)• Telford Extraction Device (TED)• Spinal Boards (Head immobilisation)• OP Airways (Various Sizes)• Oxygen Cylinder & Regulator• Bag Valve Mask• Oxygen Masks • Suction Equipment

Incident Management Kit• Glow Lights/Beacons• Ropes & Straps • Blankets• Police Cones• Incident Tape

COMMUNICATING WITH PATIENTSDealing with patients who may be distressed because of their situation & who are suffering from Injuries, an illness and or Pain may be difficult to deal with; they may be frustrated, verbally abusive, angry or violent, invariably this is not directed at the Medic but is in fact a symptom of their situation.• Remain Calm and Professional• Speak Clearly in normal language (No Jargon)• Use Empathy & Rapport • Position yourself appropriately to the threat• Reduce the Pain (Entonox/Position/GTN)• Be truthful (Especially if a procedure hurts, Say so)

Behaviour – Medical Conditions • Hypoglycaemia (Low Blood Sugar) Inappropriate

behaviour, violence appearance of being drunk• Stroke – Their speech may be slurred or garbled,

or the person may not be able to talk at all despite appearing to be awake and in mild cases my be frustrated and or Aggressive

• Mental Health – Multiple conditions with multiple degrees of emotion, frustration, Anger or Violence

• Heat Stroke (Hyperpyrexia) In severe heat stroke, they may be confused, hostile, or seemingly have intoxicated behaviour

• Drugs Overdose – Varying behaviour types from passive to extreme violence and fear

PATIENT INTERACTION

• Consent must be obtained from the Patient prior to delivering any medical intervention

• Approval/Consent can be given in several ways – Verbal Consent, Non Verbal Consent and the Consent of an Authorised Carer

• Where the Patient is Unconscious or in Cardiac Arrest & No Relative or Carer is present – You may commence treatment as delay could be fatal

• Relatives can express a view but can NOT give LEGAL Consent

• Whilst relatives cannot stop a Medic delivering care they may become aggressive if you do not stop when asked – Don’t endanger your own safety.

Language Barriers• Use Relatives or Bystanders (Avoid Breaking

Patient Confidentiality) • Allow more time so the patient can understand• Use Non – Verbal methods to reassure them,

hands, facial, Descriptive drawings• Never raise you voice in anger/frustration• Communicate information about what is

happening• Make an effort to Pronounce the Patients name

correctly• Find out if the Patients has any worries or

concerns• Do Not maintain a Silence it may seem ignorant

HAND OVER TO AMBULANCE CREW• Any Dangers – immediate or in the future• Patients Name• Patients Age (Date of Birth)• Brief history of the event – Illness or Injury• Past Medical History• Allergies (Especially Anaphylaxis)• The Mechanism of Injury (Known or Suspected)• Injuries Found/Suspected• Signs & Symptoms • Any Treatment Given• Any Medication used/taken by Patient

EXAMINATION & ASSESSMENT• Not all injuries are Obvious• History is as important as the application of

Immediate First Aid• Listening to the History prevents (?) FATAL

mistakes in treatment• HISTROY can be from the: Patient, Bystander,

Relative (if no one present – Visual)• Visual observation of the Patient/Scene• Listen carefully to How/When and What

Happened• Always be calm, confident, Assertive and

Professional

HISTORY OF THE INCIDENT• The Human body can be remarkably Resilient• As a Medic we need to understand the

possibilities involved during impact, through the Transference of Energy

• A severely damage Car is likely to have a Severely damaged person inside or outside of the Vehicle (Sometimes several metres away)

• Conversely people have died or have been paralysed from falling/tripping a road kerb stone

HISTORY OF THE INCIDENT

Sudden illness• What is the main problem? (C-ABC)• What are the patients symptoms ? • Has the patient had this before ?• Do they have Medication ? (GTN, Glucose)• When did the problem start ? (Original & New)• What changes if any since the symptoms began?• Monitor & Record – BP, B-sugars, Temperature

Pulse, Respirations, Pain (0 = none 10 = unbearable) • Respond to monitored changes

HISTORY OF THE INCIDENT• Fall from Height• Indirect pressure (Blast wave)• Imbalance of weight (Tendon Strain)

• Whiplash (Car Crash)• Sudden Impact (Hit by Object)• Gun Shot• Violence• Pressure (Crushing injury)• Insect (Bites & Stings)• Exposure (Gas, Poisons, Pathogens)

• Environmental (Heat & Cold)

MECHANISM OF INJURY• The Energy of any impact is transmitted and shared

between the bodies involved • The Energy of a Metal object strikes a human body,

that energy doesn’t stop but transfers into the tissues, creating varying amounts of damage depending on the velocity, size and resistance

Consider:

Type of Incident (A Fall down the Stairs)

Forces Produced and Applied (Speed, Direction, Energy, Sudden Stop)

Area of the body involved (Head, Body, Limbs)

Nature of injuries likely to be produced (Dependent on objects hit on the way down the stairs) , Wood, Concrete, Carpeted

MECHANISM OF INJURY• RTC (Road Traffic Collision)

Whip Lash Chest Compression

Fractures Seat Belt Injuries

Facial Injuries

Lower Limp Injuries

MECHANISM OF INJURY

• Compression• Acceleration• Deceleration• Low Energy• Medium Energy• High Energy • Shearing (Change of Speed)• Stretch• Cutting• Cavitation• Thermal Injury

MECHANISM OF INJURY

• Body generating Opposing Directional forces

PRACTICAL ASSESSMENT

• DANGER• PRIMARY SURVEY• AIRWAY• BREATHING• CIRCULATION• DISABILITY

A – ALERT

V - VERBAL STIMULUS

P – PAINFUL STIMULUS

U – UNRESPONSIVE• MONITOR every 5 – 15 minutes

Trauma Triage• Trauma triage is the prioritising of patients for

treatment or transport according to their severity of injury.

• Primary triage is carried out at the scene of an accident

• Secondary triage at the casualty clearing station at the site of a major incident.

• Triage is repeated prior to transport away from the scene and again at the receiving hospital.

Trauma Triage• The primary survey aims to identify and

immediately treat life-threatening injuries and is based on the 'ABCDE' resuscitation system.

• Airway control with stabilisation of the cervical

spine.• Breathing.• Circulation (including the control of external

haemorrhage)• Disability or neurological status.• Exposure or undressing of the patient while also

protecting the patient from hypothermia.

Trauma Triage

• Priority is given to patients most likely to deteriorate clinically

• Triage takes account of vital signs, • Is a dynamic process and patients should be

reassessed frequently. • In the UK, the 'T system' is conventionally used at

a major incident:

T - System

• Immediate priority (T1): require immediate life-saving intervention (Red).

• Urgent priority (T2): require significant intervention within two to four hours (Yellow).

• Delayed priority (T3): require intervention, but not within four hours (Green).

• Expectant priority (T4): treatment at an early stage would divert resources from potentially beneficial casualties, with no significant chance of a successful outcome (Blue).

Trauma Triage

• Smart Incident Command System (MIMMS)• Dead - patients who have a trauma score of 0 to 2

and are beyond help• Immediate - patients who have a trauma score of 3

to 10 (RTS) and need immediate attention• Urgent - patients who have a trauma score of 10 or

11 and can wait for a short time before transport to definitive medical attention

• Delayed - patients who have a trauma score of 12 (maximum score) and can be delayed before transport from the scene

Sieve - Triage• Can the patient walk? (Yes): Is the patient

breathing? No/Minor Bleeding Priority 3 (Green) • Not Breathing (After opening airway)/Major

Bleeding : Priority 1 (Red).• Breathing without resuscitation - What is the

respiratory rate? Above 30/minute or less than 10/minute: Priority 1 (Red).

• 10-30/minute: What is the pulse rate (or capillary refill time)? Less than 40 or more than 120 (or capillary refill time greater than 2 seconds): Priority 1 (Red).

• Between 40 and 120 (or capillary refill time less than 2 seconds): Priority 2 (Yellow)

Fractures & InjuriesRadius

Ulna

Posterior dislocation of the radius and the ulna

Cervical/Spinal Injuries

7

12

5

5 Fused

24 Mobile vertebra in the spine & 5 Fused

INJURY TO SPINAL CORD

Protect the Patients Quality of Life

IF IN DOUBT

Stiff Neck Collar

TED

Spinal Board

Immobilisation

HOSPITAL P1 (T1)

Incident Management Scene Management Scene Visibility

Scene management is one of the most important aspectsof First Aid – Never forget the stupidity of Humanity

Incident Management • Look Behind – Front – Left & Right• LOOK ABOVE & BELOW• WHAT HAZARDS HAVE YOU SEEN ?• Light up the Scene – HAZARD LIGHTS ON

RED – BLUE - AMBER LIGHTS FLASHING • Considerations:• FIRE (Fuels, Fabric's, Toxic Gas/Materials) • SOURCES OF COLLAPSE (Loads, Trees, Mud,

Water, Roofs, Vehicle Debris etc.)• SAFE - Exit & Entry Routes

Patients have been thrown up to 20ft from impact

Wondering injured 50 Metres plus

IMPACT ZONE5 - 10 METRES

TRAFFIC

IMMEDIATEBLOCK OFF

SAFETYZONE

Harbour AreaDiversion/HazardWarningMin 500ft

Flow of

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