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Queensland Ambulance Service – Apply First Aid eLearning program 1

Queensland Ambulance Service: Perform CPR Course eLearning program By Beyondedge

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Table of Contents

Table of Contents ................................................................................................... 2

Lesson 1 ................................................................................................................. 4

Lesson 1 cont’d ...................................................................................................... 5 Lesson 1.1 – Introduction to First Aid ............................................................................. 6 Lesson 1.2 – Legal Considerations .................................................................................. 7 Lesson 1.3 – First Aid Equipment .................................................................................. 10 Lesson 1.3 – (Helpful Hints) – Call triple zero (000) for an ambulance ........................... 10 Lesson 1.4 – Communicable Diseases ........................................................................... 11 Lesson 1.4 – (Interactive Activity) – Communicable Diseases ....................................... 13

Chapter 2 ............................................................................................................. 14 Lesson 2.1 – Recognizing an Emergency ....................................................................... 14 Lesson 2.2 – Emergency Action Plan ............................................................................. 14 Lesson 2.3 – Priorities At The Scene of a Road Accident ............................................... 18 Lesson 2.3 – (Helpful Hints) – Priorities at the scene of a road accident ........................ 19 Lesson 2.3 – (Interactive Activity) – Priorities at the scene of a road accident .............. 20

Chapter 3 ............................................................................................................. 22 Lesson 3.1 – Danger ..................................................................................................... 22 Lesson 3.2 – Response ................................................................................................. 23 Lesson 3.3 – Send For Help ........................................................................................... 24 Lesson 3.4 – Airway ..................................................................................................... 25 Lesson 3.5 – Breathing ................................................................................................. 26 Lesson 3.7 – Defibrillation ............................................................................................ 28 Lesson 3.8 – Life Threatening Bleeding ......................................................................... 29 Lesson 3.8 – (Helpful Hints) – Severe Bleeding ............................................................. 30

Chapter 4 ............................................................................................................. 32 Lesson 4.1 – Questioning The Casualty & Witnesses .................................................... 32 Lesson 4.2 – Checking the Casualty’s Vital Signs ........................................................... 33 Lesson 4.3 – Head–To–Toe Examination ...................................................................... 35 Lesson 4.3 – (Interactive Activity) – Head–to–toe examination .................................... 37 Lesson 4.3 – (Helpful Hints) – The importance of the secondary survey ........................ 38

Chapter 5 ............................................................................................................. 40 Lesson 5.1 – Chain Of Survival ...................................................................................... 40 Lesson 5.1 – (Interactive Activity) – Chain of Survival ................................................... 41 Lesson 5.2 – What is CPR? ............................................................................................ 42 Lesson 5.2 – (Helpful Hints) – What is CPR? .................................................................. 42 Lesson 5.3 – How Do I Do CPR? .................................................................................... 43 Lesson 5.3 – (Interactive Activity) – How do you perform CPR? .................................... 46

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Lesson 5.3 – (Helpful Hints) – Recovery position .......................................................... 47 Lesson 5.4 – FAQ’s About CPR ...................................................................................... 48 Lesson 5.5 – Introduction to Defibrillation ................................................................... 50

Conclusion ........................................................................................................... 55

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Lesson 1 INTRODUCTION – APPLY FIRST AID Hello and welcome to the Queensland Ambulance Service, “Apply First Aid” program. This first aid program will give you crucial information on the theory and practice of first aid. The course consists of two parts: The first involves successful completion of this theory based, interactive and flexible learning program. The second will require you to attend a practical “Apply First Aid” training session conducted by Queensland Ambulance Service to be accredited to perform first aid. One of the benefits of you successfully completing your first aid training is that the statement of attainment provides liability insurance protection. This insurance protects you in the highly unlikely event of litigation following first aid intervention. We hope you enjoy it, and thank you for taking this important step in equipping yourself with the knowledge to save lives.

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Lesson 1 cont’d INTERACTIVE INSTRUCTIONS Let’s take a moment now to talk about how this program works: I’ll guide you through the various chapters, which contain lessons made up of theory, demonstration videos and interactive components. The grey panel below contains most of the navigation and setting buttons you need to control this eLearning program. After the lesson has completed downloading you can find navigational points by rolling your mouse over the timeline. Cue-‐tips will be revealed describing the content covered at these particular points. If you ever need to pause or to resume the lesson, use the pause/play button found below the timeline. To move forward in a chapter, click the ‘next’ button found to the right of the play/pause button. If you didn’t quite understand what was just covered you can always use the ‘back’ button found to the left of the play button. The next button labelled with the speaker icon allows you to adjust the volume. To quickly navigate to a specific lesson or chapter, use the menu button found on the bottom left. Here you make your selection from the pop up menu – this is great for when you need to revise a particular topic. If you ever need to exit or close the program down, make sure to only use the ‘ EXIT’ button found on the bottom right hand side. This will ensure that your progress is recorded so when you log-‐on again you can continue where you had left off. If this is the first time you’ve used this interactive course, it is recommended you progress in a sequential manner, that is, do one lesson at a time in the order that they appear. Along the way, I’ll give you some fun interactive activities to help you engage with & apply the information you’ve learnt. At the end of each chapter, there will be a quiz to help test your knowledge… so feel free to take notes or to review the chapter to make sure you understand each one before moving ahead.

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As you progress through the course, you’ll unlock a number of ‘helpful hints’ – these helpful hints will give you useful insights, advice and personal experiences from people who know their stuff. On successful completion of all chapters and assessment quizzes, you’ll need to print out a theory completion record for this part of your course. This record will allow you to progress to the practical training part of the course. If you missed something in these instructions remember you can click back to replay what was just covered. OK, now that you know how to use and navigate this course. Let’s get started.

Lesson 1.1 – Introduction to First Aid INTRODUCTION Hello and welcome to Chapter One. In this chapter you’ll learn about the general principals of First Aid, including legal considerations, first aid equipment and communicable diseases. Don’t forget: There will be a quiz at the end, so take your time and make sure you understand each lesson before progressing forward. In this course, we will refer to the ill or injured person as the casualty; or sometimes, we’ll ask Frank to assist – he’s our stand–in for the casualty. Say hello Frank. Frank has the unique ability to turn transparent to show you how first aid can have a direct positive medical impact to your casualty. Frank will also volunteer his services in some interactive activities, which we will talk about later. Thanks Frank. Also, throughout this course we will refer to ‘you’ as the ‘first aid provider’. Let’s start with understanding the basics. Firstly, what is First Aid? Well, as the name suggests, First Aid is the earliest care given to someone who is ill or injured. It can be administered by anyone with proper training, from an ordinary person to more advanced medical practitioners, like doctors, nurses and paramedics. For minor incidents, First Aid may be all that is required to assist a full recovery. In more serious situations, First Aid can greatly increase the chances of a positive outcome for casualties.

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Ok, so why do we need to know first aid? Well, the primary objective of First Aid is to:

• Preserve life • Protect the unconscious • Prevent a casualty’s condition from becoming worse and • Promoting the recovery of the casualty

You should aim to prevent:

• Damage to yourself or bystanders • Make sure the casualty’s condition does not worsen • Avoid delays that could affect the casualty’s recovery and • Protect the casualty from harmful intervention.

First Aid can take many forms, such as reassuring a casualty, treating the casualty and contacting the ambulance service. In critical situations, it may involve giving cardiopulmonary resuscitation (or CPR) – all of which may help to save a life. In emergency situations, it is often the quick but simple actions of someone applying First Aid that ensures a casualty has the best chance of making a full recovery. Although there is no way of anticipating an emergency situation, First Aid training is the best preparation you can have in the event that someone becomes ill or injured and requires assistance. RECAP Recaps will appear at the end of every lesson and will give you a list of the keynotes from that lesson. In this lesson: The primary objectives of First Aid are to:

• Preserve life • Protect the unconscious • Prevent a casualty’s condition from becoming worse, and • Promoting the recovery of a casualty

Lesson 1.2 – Legal Considerations Here you are at the scene of an emergency. Do you know what your legal obligations are? So let’s deal with this issue right now:

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A common concern that people have about administering First Aid is the risk of legal liability, which could arise from assisting an injured or ill person. It’s important to consider all the legal implications in some detail, so that you do not feel apprehensive about offering assistance. Once you know how the law works, you should feel confident in your approach to situations that require First Aid. It should be noted that in Australia to date, there has never been any successful legal action brought against someone who was trying to administer First Aid to a person in need. Therefore, when you work within the guidelines of your current first aid training and act carefully with full and proper consideration for the welfare of the casualty, you should feel confident in applying first aid. Remember, in life threatening situations, any form of assistance is likely to be of greater benefit than no assistance at all. One of the benefits of you successfully completing your first aid training with the Queensland Ambulance Service is the statement of attainment provides liability insurance protection. This insurance protects you in the highly unlikely event of litigation following first aid intervention. Here are some basic legal expectations you should know and comply with. Before administering first aid, you must obtain the consent of the casualty to begin first aid. This is to preserve their right to refuse any unwanted form of personal contact. A casualty’s consent is valid when:

• Their decision is made voluntarily • Their decision is informed • Their decision covers the first aid treatment to be performed, and • They have the capacity to provide consent.

It is not uncommon to come across a person who, due to injury or illness, is unable to consent to the first aid treatment being offered. Lets talk about ‘Capacity to consent’ in some detail: People who are considered to lack adequate capacity to provide consent include:

• A person who has diminished ability to understand or communicate the nature and consequences of their decision, for example, a casualty who is unconscious or confused.

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• A minor, who in Australia or New Zealand is someone under 18 years of age

If you do not live in these countries, please check your local laws for information on the age limit of minors. If the casualty is a minor, then attempt to get permission from their parent or guardian to apply first aid. If they are not with the minor, or treatment will be delayed whilst seeking their consent, then consent can be inferred. However, it is important to remember, if a casualty cannot provide direct consent and First Aid could prevent death or serious injury, then the general principals governing consent may not apply, as it assumed the casualty would agree to being helped. For some employees with First Aid training, it is expected that they will offer assistance to their workmates should the need arise. This was known as “duty of care” but is now referred to as obligation. It is expected that you will always operate within the guidelines of their first aid training and with consideration for the welfare of the casualty. Under Australian law, a First Aid provider is not compelled to render assistance unless they are under obligation. In accordance with Queensland law, there is an obligation imposed on the driver of a motor vehicle involved in a road traffic crash. They are required to:

• Stop at the scene • Render any assistance to the best of their ability and • Call for medical assistance

If you decide to provide assistance, you are then obligated to continue the treatment until: The casualty recovers, more advanced carers arrive, the accident scene becomes a danger to you or the casualty refuses treatment. A breach of obligation occurs when you as a First Aid provider fails to act in accordance to your first aid training. It can be determined that you have breached your obligation of care if you have provided first aid outside of the limits of your first aid training and you have not remained with the casualty until more experienced medical care arrives. These expectations may be affected, however, by the conditions and circumstances by which the first aid care is provided. Allowance maybe made for the particular stress of a situation. For example, the expectation of a single first aid provider at a multi casualty incident may be different to the provision of first aid to a single casualty.

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RECAP So, in summary, the legal expectations of you as a First Aid provider is:

• To obtain consent of the ill or injured, where possible and • To render assistance carefully, having regard for their level of skill and the

circumstances in which they have rendered assistance.

Lesson 1.3 – First Aid Equipment Okay, so now that you understand what First Aid is and the legal aspects you need to consider, let’s take a look at some of the equipment you are likely to use. The most common accessory is a First Aid kit, and having one on hand means you will always be prepared to respond to accidents and emergency situations. First Aid can be performed with whatever equipment is available. Ideally a first aid kit, with sterile supplies and a variety of dressings and bandages however, in an emergency situation you may need to improvise. For example, you could use a clean towel or a jumper in the treatment of your casualty; which will be better than not using anything at all. In more serious incidents such as cardiac arrest, Automated External Defibrillators (or AED’s) may be required. They are intended to be used by everyday people in the home, workplace and community. An AED is a portable electronic device that assists the heart to regain its normal, healthy rhythm, which is necessary for a casualty to survive cardiac arrest. You may re–start the heart by using a defibrillator to give an electric shock. Defibrillation increases the casualty’s chances of survival when combined with immediate and effective CPR. RECAP Remember, being prepared with first aid equipment is important. So contact the Queensland Ambulance Service for more information on first aid kits, automatic external defibrillators and oxygen resuscitation equipment.

Lesson 1.3 – (Helpful Hints) – Call triple zero (000) for an ambulance I’d like to go through some of the questions that are asked when ringing for an Ambulance and to explain to you the importance of why we ask those questions the two first questions that we ask are the most important questions, they are; Where are you? What suburb are you at? Know where your at, where you are so we can send a Ambulance there if you don’t know where you are I can’t send you an Ambulance. The second most important thing is what is the phone number that you are calling from so if the line disconnects, or I need to call you back to get some more details then I’ve got a phone number that I’m able to contact you directly on. Those are the

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two most important questions without those we cannot get an Ambulance to you, the next question we will ask is what’s the problem tell me exactly what’s happened? We will also ask the age of the patient, will also ask whether they are male of female? Are the conscious? Are they breathing? People often stumble over are they conscious do you have an understanding of what that means that means are they awake are they alert are they able to respond to you in some way and then the next one is are they breathing. The reason why we will go through and ask these different questions is so that we can get the right Ambulance to you with the right skilled paramedic onboard we have paramedics that have different skills and depending on what condition you have will determine what style of paramedic you will get.

Lesson 1.4 – Communicable Diseases So, you arrive at the scene of accident and you are ready to administer first aid. But are you aware of the risks posed by communicable diseases? Communicable diseases are diseases that can be spread from one person to another. They may be in the form of bacteria, viruses, fungi, mites or lice. Some examples include:

• Colds and flu • Measles or mumps • Various strains of Hepatitis • HIV infection • Herpes, and • Some forms of Meningitis.

Communicable diseases are transmitted by the transfer of body fluids and other body micro–organisms, such as:

• Blood • Saliva • Vomit • Urine, and • Faeces

So how are diseases transmitted? Let’s talk about how communicable diseases are spread; which is the means by which communicable diseases can spread between people. Firstly,

• Droplet / airborne transmission: This occurs when droplets of fluid escape from the nose or mouth of an infected person during a sneeze or cough.

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• Other airborne transmission: This can be a form of droplet transmission, but it can also occur when microorganisms are carried by air currents through ventilation or air conditioning systems.

• Transmission by contact:

Viruses and germs can cause infection when contaminated blood or body fluids come into direct contact with skin, eyes or mucous membranes, such as the inside of the mouth or nose. Infection can also occur indirectly by contact with blood–soaked contaminants, such as bandages and clothing.

• Vector–borne transmission: Contaminated objects, including hypodermic needles, fall within this category, as do living micro–organisms such as mosquitoes. These are referred to as vectors. Examples of vector–borne infections include Malaria, Dengue Fever and Ross River Fever.

You need to protect yourself and casualties from communicable diseases by minimizing contact with blood and other bodily fluids. There are standard precautions that can be followed to ensure safety, however a good rule of thumb is to treat all blood and bodily fluids as contaminated, and act accordingly. Therefore, wherever possible, you should:

• Wear Personal Protective Equipment (PPE) such as gloves, boots and goggles • Avoid contact with objects that may be contaminated • Wash your hands thoroughly with soap and water before and after

administering First Aid • Cover your own exposed cuts and grazes with waterproof dressings • Avoid eating, drinking and other forms of hand–to–mouth contact whilst

administering first aid • Change gloves before handling different casualties to minimize the possibility

of cross–infection between casualties • And seek medical aid as soon as possible if contamination by infected blood

or body fluids occurs RECAP Communicable diseases can be spread in a number of ways:

• Bodily fluids • Through the air • Through direct contact and • By contaminated objects

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You should always ensure you wear the right protective clothing and follow proper hygiene procedures.

Lesson 1.4 – (Interactive Activity) – Communicable Diseases Welcome to your first activity. Throughout this course, there will be a number of places where you will get a chance to apply your knowledge with an activity. These activities are not assessed – They are just a way for you to check your application of the concepts covered. Now that you’ve learnt about cross infection, let’s take a look at a couple of videos together. Watch the video and notice the First Aid Provider is performing a procedure that increases the risk for cross–contamination Write down any incorrect procedures you notice. Write down any incorrect procedures you notice. Then at the end of the clip, you’ll get a list of possible risks. Use the mouse to tick off all the risks you’ve detected during this scene. You can ‘Pause” the video to write down the risks or simply replay the clip as many times as you like. Depending on your result you may wish to try again. You will then be shown the video showing the correct procedure on how to avoid cross contamination. OK, ready to go? QUIZ That’s the end of chapter one, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 2 Lesson 2.1 – Recognizing an Emergency Hello and welcome to Chapter two. In this chapter you will learn how to recognise an emergency situation, how to formulate an emergency action plan and what the priorities are at the scene of a road accident. The first step in responding to an emergency is to ‘recognise’ there is an emergency situation. An emergency situation is when someone requires immediate medical assistance. This is usually either a medical emergency from a sudden illness, such as someone suffering chest pain, or a traumatic emergency, like someone fracturing their arm after a motor vehicle incident. An emergency can happen anywhere and at anytime, so preparation is the key.

Lesson 2.2 – Emergency Action Plan Many variables exist in emergency situations and First Aid treatments could be critical in preventing a casualty’s condition from deteriorating before paramedics arrive at the scene. Knowing in advance just what to do and when to do is the key to helping you to stay calm and manage the initial apprehension you may feel in an emergency. After recognising an emergency situation, a systematic approach must be applied. It’s called an Emergency Action Plan. The steps are as follows:

• Surveying the scene • Determining whether the scene is safe • Phoning for help • Assess for life threatening injuries, and • Conducting a secondary survey.

By following the steps in the emergency action plan, you are ensuring that the needs of the casualty and the situation are correctly prioritised. It is also less likely that important information about the casualty’s condition, or the emergency will be missed. Ok, so what’s a scene survey? Put simply, it is an overall evaluation of the situation that is made by you before any action is taken to help a casualty. It is mainly concerned with recognising hazards

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and determining the information that will be required when a call is made to activate ambulance services. So how do we go about surveying a scene? The process of surveying an emergency scene involves:

• Determining if the scene is safe • Taking reasonable steps to reduce the risk of existing hazards • Determining what has happened • Determining how many casualties are involved and the nature of their

injuries, and • And using bystanders to call for help, if possible

Hazards at the scene of an accident or medical emergency are identified and gauged according to the risk they pose to each of the three categories of people likely to be present. In order of priority, these are:

• The First Aid provider (that’s you) • Any bystanders • And the casualty

It may be the case that you are the only person capable of rendering assistance or calling for help and, as such, you must ensure not to endanger yourself and become an additional casualty. Bystanders should be warned about any dangers and kept at a safe distance to ensure they do not become casualties. Once the scene is considered safe, bystanders can be asked to assist if needed. Any hazards that may be present should be removed or controlled in such a way that will prevent further injuries, but only if it is safe to do so. It is also a good idea at this point to have a quick look around to ensure that there are no dangers developing. Situations involving hazards that are not easily controlled should be left for the attention and management of emergency service personnel who have the specialised training and equipment necessary to deal with them safely. The kinds of danger that need to be considered at an emergency scene can take many forms, such as traffic, used syringes, fallen power lines, fire, extreme weather, leaking fuel or gas, toxic fumes, unstable structures, bodies of water, poisonous substances, dangerous animals and the unpredictable actions of bystanders. Casualties also pose a danger to the first aid provider with the potential for the transmission of communicable diseases. To reduce the risk of transmission of

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communicable disease, use proper personal protection when available. You can refer to the previous chapter if you need a refresher. Things to consider if the casualty has to be moved:

• Avoid bending or twisting the casualty’s neck and back. Remember, spinal injuries can be aggravated by rough handling.

• Try to have three or more bystanders to assist in the support of the head and neck, the chest, the pelvis and limbs.

• If no bystanders are present, the first aid provider may need to drag the casualty to safety (either with an ankle drag or arm-‐shoulder drag depending on the situation).

Once it has been determined that the scene is safe, it is important to establish what has actually occurred. If you have not directly witnessed events leading to the emergency, any bystanders should be asked whether they saw what happened. If nobody has witnessed the incident, search for clues to work it out. It is important to have an understanding of how the emergency situation came about in order to know what kind of first aid is most likely to be needed. It will also form the basis of the information that will be provided to paramedics when they arrive. It is important to look thoroughly around the scene of an emergency incident to determine how many casualties are involved. This information will be required by the ambulance service, and will help you to establish priorities. When approaching a scene, look carefully for more than one casualty. At a road traffic accident, always look under the passenger side dash and in the back seat floor area, to ensure that no casualties, particularly small children and infants, have slipped forward off the seats. Also check the surrounding area to ensure that no casualties have been thrown from a vehicle. Use bystanders if possible to help you, or ask them to call triple zero (000) to activate the ambulance service. Bystanders can act as traffic control until the police service arrive, direct emergency services to the scene and assist with the treatment of a casualty. If there are no bystanders immediately present, you can shout out to try and attract the attention of someone who can help you. In any emergency situation involving sudden illness or injury, it is essential that the ambulance service be contacted as soon as possible. Remember, First Aid is interim assistance until more advanced medical care can be provided. Serious cases need qualified medical attention without unnecessary delay. In some circumstances, such as emergency situations at which bystanders are present, it is possible to call for an ambulance prior to determining whether the scene is safe. By getting a bystander to call triple zero for an ambulance, it enables you to remain with the casualty and provide ongoing care.

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If the person making the call to the ambulance service has to leave the scene, it is important that they know to report back once the call is made. They may be able to offer other forms of assistance to you once the call for ambulance assistance has been made. For example, conveying any treatment advice that may have been offered by the emergency medical dispatcher receiving their call. When a call is made to the Ambulance Service, a trained emergency medical dispatcher will ask the caller a number of questions. The questions are likely to include the following:

• What is the exact location of the incident/accident? • What is the phone number from which you are calling? • What has happened? • How many people are sick/injured? • What is the nature of the casualty’s injuries? • Are you with the casualty now? • How old is the casualty? • Is the casualty conscious? • Is the casualty breathing?

Make sure you remain calm and your responses are clear and concise. The emergency medical dispatcher will dispatch the ambulance paramedics and provide you with First Aid advice. Remember not to end the call until you are told to do so by the emergency medical dispatcher. Now let’s look at assessing for life threatening injuries. This step involves the assessment of and response to the casualty’s vital signs and life threatening conditions that could lead to loss of life. The first thing you should check

• Is a casualty’s response • Then their airway • And if they are breathing normally. • After these vital signs have been assessed, it is important to then check for

any life threatening bleeding. So what is a secondary survey? A secondary survey allows a more thorough and systematic examination of the casualty conditions or injuries that were not initially apparent. Do not commence a secondary survey if any life–threatening conditions are present. You will learn more about how to conduct a secondary survey in Chapter 4.

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RECAP So, in summary, the Emergency Action Plan is: Survey The Scene

• Is the scene safe? • What happened? • How many casualties are there? • Are there any bystanders to help? • Determine whether the scene is safe • For yourself • Bystanders, and • The casualty.

Call triple zero and ask for the ambulance service

• Listen carefully to the emergency medical dispatcher • Give the exact location • Give the call back phone number • Provide incident details and the casualty’s condition. If possible, send a

bystander to make the call. • And remember to hang up last.

Assess For Life Threatening Injuries

• Response • Airway • Breathing normally • Severe bleeding

Conduct A Secondary Survey

• Question the casualty and bystanders • Check vital signs • Conduct a head–to–toe examination

Lesson 2.3 – Priorities At The Scene of a Road Accident Now that you have learned how to formulate an Emergency Action Plan, let’s have a look at how you can manage a road accident. It’s important to note that one of the biggest life threatening risks to casualties of road accidents is obstruction of their airway. Okay, here’s how you should approach a traffic accident:

• Conduct a scene survey. • Determine whether the scene is safe.

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• Remove or control any hazards if safe to do so. – This includes turning off the ignition of a crashed vehicle – Warning approaching vehicles – Not touching a vehicle, or attempting to rescue a person from within six metres of a fallen high voltage power line unless the electricity authority has declared the area safe – Warning the casualties and bystanders not to smoke.

• Determine the number of casualties and the nature of their injuries. • Call triple zero for help. • Assess and assist the injured casualties

– Firstly, go to any unconscious casualties and assess for life threatening injuries. – If the person is unconscious and trapped in the vehicle, the casualty’s airway must be cleared of foreign material, and then head tilt and jaw support should be maintained. – Attending to any conscious casualties – Carefully assist any casualties from the vehicles – Stopping any bleeding – Immobilizing any obvious fractures – Rest and reassuring the casualty, and – Regularly monitoring and recording vital signs, including pulse, breathing, level of consciousness and pupil reaction.

RECAP For a road traffic accident you should:

• Conduct a scene survey. • Determine whether the scene is safe. • Remove or control any hazards if safe • Determine the number of casualties and the nature of their injuries. • Phone for help. • Assess and assist the injured casualties. • You should always ensure you wear the right protective clothing and

follow proper hygienic procedures.

Lesson 2.3 – (Helpful Hints) – Priorities at the scene of a road accident Yeah, well if you do come across a motor vehicle accident my advice would be that you stay a safe distance away from the incident; preferable behind the incident two to three vehicle distances away, put your hazard lights on and then approach the scene if it is safe to do so to see if anyone needs assistance.

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If you’re on a highway or a motorway where there is a fair amount of traffic. If you can the assistance of a truck driver to use his truck as a barrier between the accident scene and oncoming traffic put his hazard lights on and maybe put out his hazard markers further back. That would be the safest way to approach a motor vehicle accident. The information the emergency services would require would be if there was any chemicals involved we need to look for things known as HAZCAM indicators or markers on the trucks in particular. There a diamond shape marker or sign on the truck and all you need to do is quote the numbers that are and the chemicals mentioned to the Ambulance service if you ring them first you also need to check to see how many people were involved in the accident is anybody trapped in particular because will notify the QLD Fire and Rescue Service to also attend and come out with there jaws of life to help extricate the patient from the vehicle.

Lesson 2.3 – (Interactive Activity) – Priorities at the scene of a road accident Now that we have learnt all about the hazards at the scene of a road accident it’s time to test your knowledge with another activity. Remember these activities do not count towards your final score, so you can relax. In this activity you required to analyse the accident scene and identify the possible hazards. Simply click on any areas that you think is a priority until you have found them all. Pop-‐up descriptions will appear when you roll over items. A running tally of how many priorities will need to be found is located below the timer. Don’t forget; you are also racing against the clock, just like you would in real life. If you do run out of time don’t worry you have the option to try again or have all the priorities areas automatically revealed. Ok, Ready to go? QUIZ That’s the end of chapter two, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter.

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Ready to go?

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Chapter 3 INTRODUCTION Hello and welcome to chapter 3. In this chapter you will learn how to assess for life threatening injuries using the steps of the basic life support flowchart. A life-‐threatening injury is an injury that could possibly be fatal to the casualty if first aid is not applied as soon as possible. As you arrive at the scene of an incident you should remember the following steps by using the acronym D.R.S.A.B.C.D or Doctors A.B.C.D. That stands for: 1. Danger 2. Response 3. Send for Help 4. Airway 5. Breathing 6. CPR 7. Defibrillation These steps, as well as how to treat life-‐threatening bleeding, will be covered in more detail throughout the chapter.

Lesson 3.1 – Danger The first step after arriving at an emergency situation is to assess the incident for DANGER, as discussed earlier in Chapter Two. It is important to survey the scene and determine whether there are any dangers or hazards to you, the casualties or any bystanders. The kinds of danger that need to be considered at an emergency scene can take many forms, such as traffic, used syringes, fallen power lines, fire, extreme weather, leaking fuel or gas, toxic fumes, unstable structures, bodies of water, poisonous substances, dangerous animals and the unpredictable actions of bystanders. Any hazards that may be present should be removed or controlled in such a way that will prevent further injuries, but only if it is safe to do so. It is also a good idea at this point to have a quick look around to ensure that there are no dangers developing.

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Situations involving hazards that are not easily controlled should be left for the attention and management of emergency service personnel who have the specialised training and equipment necessary to deal with them safely. Once the incident has been deemed safe, you can begin to start assessing the casualty for life-‐threatening injuries using the RESPONSE method.

RECAP So remember: Check for DANGER

• Your safety is the first priority so survey the scene for dangers and developing dangers before attending to casualties.

• Only remove hazards if it is safe to do so, otherwise, leave it for emergency services personnel

Lesson 3.2 – Response The first step in assessing for life–threatening injuries is to determine the casualty’s level of consciousness, often indicated by their ability to respond. Initially, this should be done through the “talk and touch” method, ensuring that you do not aggravate any injuries. You should never shake casualties when checking for their response, especially infants or children. Checking for a response should only incorporate gentle touching and loud talking. A good way to remember the questions and directives that enable you to assess response is the acronym COWS:

– Can you hear me? – Open your eyes – What’s your name? – Squeeze my hands

There are three levels of consciousness: • Conscious:

A state in which a person responds normally to questions and requests, such as those relating to the day, date, time and where they are

• Altered level of conscious:

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A state in which a person responds to questions in a way that indicates they may be confused, disoriented, have altered thinking or a marked impairment of awareness

• Unconscious: A state in which a person is not able to respond at all

A casualty who responds normally is conscious and breathing. At this point, you should identify yourself and obtain consent to apply first aid. It’s a good idea to ask the casualty their name, as using it will reassure them while you assess their injuries. A casualty who does not respond could be unconscious and, if so, is likely to be in a life–threatening situation. The two main concerns for an unconscious casualty are that they are unable to protect themselves from any danger and that they are unable to manage their own airway. When the respiratory system is not functioning effectively there is a disruption in the supply of oxygen to the brain. This can lead to unconsciousness in a few seconds and permanent brain damage in just minutes. If the casualty is unresponsive, call triple zero to request ambulance assistance, then assess for a clear airway and whether or not the casualty is breathing normally. RECAP So to recap: Check responsive; use the COWS method:

– Can you hear me? – Open your eyes – What’s your name? – Squeeze my hands

Three Levels of Consciousness:

• Conscious – responds normally to questions and requests • Altered level of conscious – responses to questions indicate they may be

confused and disoriented • Unconscious – a state in which a person is not able to respond at all

Lesson 3.3 – Send For Help Once you have identified that the casualty is in a life-‐threatening situation, you must call triple zero (000) immediately for assistance.

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In any emergency situation involving sudden illness or injury, it is essential that the ambulance service be contacted as soon as possible. Remember, First Aid is interim assistance until more advanced medical care can be provided. In some circumstances, such as emergency situations at which bystanders are present, it is possible to call for an ambulance prior to determining whether the scene is safe. By getting a bystander to call triple zero for an ambulance, it enables you to remain with the casualty and provide ongoing care. If the person making the call to the ambulance service has to leave the scene, it is important that they know to report back once the call is made. They may be able to offer other forms of assistance to you once the call for ambulance assistance has been made. If there are no bystanders immediately present, you can shout out to try and attract the attention of someone who can help you. RECAP So to recap, remember:

• Send for Help • First Aid is only interim assistance so it is essential to call 000 for

assistance. • If possible, get a bystander to call triple zero for an ambulance as it

enables you to remain with the casualty and provide ongoing care. • And if there is no bystanders immediately present, you can shout out to

try and attract the attention of someone who can help you.

Lesson 3.4 – Airway Now that you’ve learned how to check for response, it is important to learn how to check a casualty’s airway. Start by looking in the mouth for foreign bodies such as food, loose dentures or fluid. DO NOT TILT THE HEAD BACK UNTIL THE MOUTH IS CLEARED OF ANY FOREIGN MATERIAL. Let me repeat that: DO NOT TILT THE HEAD BACK UNTIL THE MOUTH IS CLEARED OF ANY FOREIGN MATERIAL. Otherwise, you risk blocking the airway with this foreign material.

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Dentures should only be removed if loose or if they could possibly cause an airway obstruction. If secure, leave the dentures in place as it will help to ensure a good seal if rescue breathing is necessary. If water, vomit, blood or other fluid obstructs a casualty’s airway, place the casualty in the recovery (or side) position, sometimes referred to as the lateral position, which results in a sideways, slight downward tilting of their face. This position uses gravity to move the tongue away from the airway and assists with the draining of liquids from the mouth and also allows you to use the finger–sweep technique to clear the airway. The finger–sweep technique utilises the index and middle fingers to perform a sweeping action in the casualty’s mouth to remove the foreign body. And remember, do not probe during the process of clearing an airway, as it may push foreign material further into the airway and make it more difficult to clear. RECAP So let’s recap:

• Check the airway • First check for foreign bodies in the casualty’s mouth • Do not tilt the head back until the mouth is clear of any foreign material • Clear the mouth using finger sweep technique • Do not probe during the process of clearing the airway

Lesson 3.5 – Breathing The next step in the basic life support process is breathing. Once it is established that the casualty’s airway is clear, you should then check if they are breathing normally. This is done through the look, listen and feel technique:

– Look for the rise and fall of the chest by placing your hand on the casualty’s stomach – Listen for the movement of air by placing your ear near their nose and mouth – Feel for the movement of air from the nose and mouth against your cheek.

If the casualty is breathing normally, and not already in the lateral or recovery position, then move them into this position, taking great care to avoid twisting the head, neck or spine. Remember, establishing and maintaining a clear airway always takes precedence over any injury, including a suspected spinal injury. To move someone into recovery position:

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• Move the casualty’s arm that is furthest away from you out to the side of the casualty

• Place the casualty’s arm that’s closest to you over the casualty’s chest • Lift the casualty’s leg by bending the knee that’s closest to you. • Grasp the casualty’s shoulder that’s closest to you and place the other

hand on the casualties hip • Gently roll the casualty away from you, keeping the casualties head, neck

and spine straight • Position the casualty so their hand and bent knee supports them in the

recovery position, and • Gently tilt the casualty’s head slightly back and downwards to allow for

drainage

While the casualty is on their side in the recovery position, it is important to regularly check their airway and breathing. You should then immediately check for any life threatening bleeding. If any life threatening bleeding is found, then control it immediately. You should also commence a secondary survey while you wait for paramedics to arrive. RECAP So to recap, to check for breathing you:

– Look for the rise and fall of the chest by placing your hand on the casualty’s stomach – Listen for the movement of air by placing your ear near their nose and mouth – Feel for the movement of air from the nose and mouth against your cheek

To move someone into recovery position: • Move the casualty’s arm that is furthest away from you out to the side of the casualty • Place the casualty’s arm that’s closest to you over the casualty’s chest • Lift the casualty’s leg by bending the knee that’s closest to you. • Grasp the casualty’s shoulder that’s closest to you and place the other hand on the casualty’s hip • Gently roll the casualty away from you, keeping the casualties head, neck and spine straight • Position the casualty so their hand and bent knee supports them in the recovery position, and • Gently tilt the casualty’s head slightly back and downward to allow for drainage

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Lesson 3.6 -‐ CPR The next step in the D.R.S.A.B.C.D method is CPR or Cardiopulmonary resuscitation. If you have determined that the casualty is not breathing normally and is unresponsive it means they are in cardiac arrest and you will need to commence CPR as soon as possible. CPR requires the First Aid Provider to administer 30 chest compressions at a rate of 100 compressions per minute followed by 2 rescue breaths to the casualty. These are to be repeated until paramedics can take over, the casualty becomes responsive and starts breathing normally, it becomes impossible for you to continue or there is a danger to yourself. If the casualty starts breathing normally but remains unresponsive, roll them into the recovery position and monitor their breathing. It’s a good idea, if available, to have two people performing CPR on a casualty, as to prevent fatigue of the first aid provider. RECAP

• If the casualty is not breathing normally and is unresponsive, commence CPR as soon as possible.

• CPR requires 30 chest compressions followed by 2 rescue breaths to the casualty.

• These are to be repeated until paramedics can take over, the casualty becomes responsive and starts breathing normally, it becomes impossible for you to continue or there is a danger to yourself.

• If the casualty starts breathing normally but remains unresponsive, roll them into the recovery position and monitor their breathing.

Lesson 3.7 – Defibrillation Defibrillation is the best possible chance to resuscitate someone who is in cardiac arrest. The sooner defibrillation is attempted, the more likely a positive result will occur. For every minute a defibrillator is not used, the casualty’s chances of survival decreases by 10% An Automated External Defibrillator or AED as they are commonly known, have been developed for use by laypersons. The AED gives out easy to follow voice prompts and

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picture instructions for its use. If you have determined the casualty is in cardiac arrest and have access to an AED, use it in conjunction with CPR

If you do not have an AED available, continue CPR until an emergency medical professional arrives or signs of life return, as the paramedics will be equipped with a defibrillator

How to use an AED will be discussed further in Chapter 5. RECAP So to recap, remember:

• Defibrillation is the best possible chance to resuscitate someone who is in cardiac arrest

• An Automated External Defibrillator or AED has been developed for use by laypersons.

• If you have determined the casualty is in cardiac arrest and have access to an AED it is best to use it before commencing CPR.

• If you do not have an AED available, continue CPR until an emergency medical professional arrives, as they will have a defibrillator with them

Lesson 3.8 – Life Threatening Bleeding The final lesson in this chapter is about life threatening bleeding. You should identify and immediately control any life threatening bleeding. This simply requires the casualty to be scanned from head–to–toe to detect signs of external bleeding. Bleeding is considered life threatening when it is spurting or cannot be controlled and must be treated as quickly as possible. This is the recommended treatment for life threatening bleeding:

• Rest and reassure the casualty • Call Triple Zero for an ambulance immediately • Ensure you wear the correct personal protective equipment. • Apply pressure to the wound using a pad and bandage. • Elevate the wound if possible. • Regularly monitor and record the casualty’s vital signs. • Reassure and calm the casualty until paramedics arrive.

RECAP So to recap, the important points to remember when assessing and attending to casualties with life-‐threatening injuries are:

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• D for DANGER

Check for hazards that could possibly harm yourself, bystanders or the casualty

• R for RESPONSE Once the area is safe, check the casualty for a response.

• S for SEND FOR HELP If the casualty is unresponsive, send for help by either calling 000 yourself or by asking a bystander to call for you.

• A for AIRWAY Check and clear the airway of the casualty of any foreign bodies.

• B for BREATHING Check the casualty is breathing by using the Look, Listen and Feel method.

• C -‐ CPR If the casualty is not breathing, commence CPR by administering 30 chest compressions followed by 2 rescue breaths. Continue until help arrives.

• D for DEFIBRILLATION If available, use an AED and commence defibrillation on the casualty in cardiac arrest.

IF LIFE-‐THREATENING BLEEDING is identified then it should be controlled by:

• Resting and reassuring the casualty • Calling Triple Zero for an ambulance immediately • Ensuring you wear the correct personal protective equipment. • Applying pressure to the wound using a pad and bandage. • Elevating the wound if possible. • Regularly monitoring and recording the casualty’s vital signs. • Reassuring and calming the casualty until paramedics arrive.

Lesson 3.8 – (Helpful Hints) – Severe Bleeding In severe bleeding from an Ambulance perspective we would like to ask the patient if/or the bystander if they could perhaps find a clean towel or a blanket or a nice clean shirt of some sort relatively we like to keep it dry we would ask that they apply firm but gentle pressure to the area without pushing to much on the open wound its very important that once we do apply that pressure we don’t take the if its a towel or whatever it is we don’t take that away from the wound and will keep that pressure on should bleeding go through the original towel we ask that you get a second object whether it be a still again a blanket or shirt and re–apply that on top of the original blanket or towel that you have. In relation to haemorrhage control I

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have recently proceeded to a case in the local area to a construction site where on arrival we found that a gentlemen had a circular saw injury which had penetrated his groin on arrival we found that his boss who was on scene who had a towel had applied really great haemorrhage control he put the towel on the sight of injury and didn’t move it until we arrived, there wasn’t a significant haemorrhage loss at this point of time but having that initial haemorrhage control allowed us to then focus on other part of the treatment he remained at that site while we continued re–assessing the patient he did really well he didn’t remove it the clot remained in place and we were able to give the gentlemen further treatment like fluids to get his blood pressure back up because the haemorrhage was controlled until/or by the time we had got on scene. QUIZ That’s the end of the chapter, so you know it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go?

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Chapter 4 INTRODUCTION Hello and welcome to chapter four. In this chapter you will learn how to conduct a secondary survey. This involves questioning the casualty and witnesses, checking the casualty’s vital signs and conducting a head–to–toe examination. A secondary survey is a more comprehensive and systematic assessment of a casualty and is designed to identify any less obvious conditions. The process of a secondary survey involves three steps:

• Questioning the casualty and witnesses • Continuing to check vital signs, and • Conducting a head-‐to-‐toe examination

Lesson 4.1 – Questioning The Casualty & Witnesses Here you are at the scene of an incident. How can you determine how a casualty became ill or injured? The best method is to observe what you see around the incident site and to question the casualty and witnesses. The term DOLOR is used to remind first aid providers of some simple questions that could be asked of a casualty: D – description: ask the casualty to describe the problem O – onset and duration: ask the casualty when the problem started and how it progressed L – location: ask the casualty where on the body the problem is O – other signs and symptoms: do you notice any other signs or is the casualty aware of other symptoms? R – relief: has anything provided relief. For example, rest, medication, positioning When speaking with the casualty, always offer reassurance, this will ease anxiety and stress that can have a negative affect on their condition. If it is difficult to communicate with the casualty, due to unconsciousness, injury, language barriers or age, question any witnesses or bystanders to establish the history of the incident. If there are no witnesses, your only option will be to make your own observations about the casualty and the incident site. RECAP

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The term DOLOR is used to remind first aid providers of some simple questions that could be asked of a casualty: D – description: ask the casualty to describe the problem O – onset and duration: ask the casualty when the problem arose and how it progressed L – location: ask the casualty where on the body the problem is O – other signs and symptoms: do you notice any other signs or is the casualty aware of other symptoms? R – relief: has anything provided relief. For example, rest, medication, positioning

Lesson 4.2 – Checking the Casualty’s Vital Signs So, having questioned the casualty and witnesses, you may have a clear picture of how the incident occurred. The next step in the process is to check the casualty’s vital signs. These are indicators of whether the body is acting normally or if it’s trying to make adjustments due to injury or illness. Vital signs are:

• Conscious level • Breathing • Pulse, and • Skin Colour

You need to pay close attention to vital signs, checking and recording them regularly until the paramedics arrive. Adults at rest breathe between 12 and 18 times per minute. Children at rest between 1 and 8 years old breathe slightly faster at 15 to 30 times per minute. Infants at rest under 1 year can breathe 25 to 50 times per minute. You need to regularly check for any change to a casualty’s breathing which could indicate their condition is improving or declining. Signs of abnormal breathing include:

• Gasping • Noisy breathing, such as wheezing or gurgling • Breathing that is excessively fast or slow • Pain when breathing.

Every time the heart contracts, it forces blood around the body through the circulatory system. This is referred to as a person’s pulse. If a pulse is present, it may be felt by placing two fingers over one of the radial arteries in the wrist, or over the carotid artery in the neck.

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A normal resting pulse rate for adults is generally between 60 to 100 beats per minute. A normal resting pulse rate for children is generally between 70 and 140 beats per minute, while infants under 1 year of age are usually 90 to 160 beats per minute. A change in someone’s normal pulse rate could indicate an improvement or worsening in their condition and can be indicated by:

• Irregularity • Weakness • A pulse that is too fast or too slow.

If the casualty is in shock due to blood loss, the radial pulse might be hard to find as the body redirects blood from the extremities to vital organs. In this instance, feel for a pulse in the neck and remember if they’re breathing then they must have pulse. To check for a casualty’s radial pulse:

• Turn the casualty’s hand palm–side up, and then place your two fingers along the outer edge of the casualty’s wrist just above where their wrist and thumb meet.

• Slide your fingers toward the centre of the casualty’s wrist. You should feel the pulse between the wrist bone and the tendon.

• Press down with your fingers until you feel the casualty’s pulse. Do not press too hard, or you will not be able to feel the pulsation.

• Continue to feel the pulse for a full minute. • Record this pulse rate and the time it was taken.

To check for a casualty’s neck pulse:

• Gently tilt the casualty’s jaw upwards, and place your first two fingers of your hand at the casualty’s chin.

• Move your fingertips gently downwards along the windpipe and throat. • Press down with your fingers until you feel the casualty’s pulse. Do not

press too hard, or you will not be able to feel the pulsation. • Continue to feel the pulse for a full minute. • Record this pulse rate and the time it was taken.

The last vital sign to check is skin colour, as it can give critical early clues about their condition. A casualty who is suffering from shock from blood loss may be sweaty and will have pale skin that is cool to touch. This is because the body redirects blood away from the skin’s surface to support the functioning of the vital organs. Whereas flushed (very red) skin could indicate to high blood pressure or suffering an allergic reaction.

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RECAP Vital signs are indicators of whether the body is functioning normally or if it’s trying to make adjustments due to injury or illness. Vital signs are:

• Conscious level • Breathing • Pulse, and • Skin Colour

You need to pay close attention to vital signs, checking and recording them regularly.

Lesson 4.3 – Head–To–Toe Examination The final lesson in this chapter is the head–to–toe examination. This is a step–by–step search for any injuries that are yet to be identified. It prioritises the more serious injury locations. These injuries should be treated in the order in which they are found. The sequence is:

• Head • Neck • Chest or back • Abdomen • Pelvic area • Legs • Arms

Obviously, it will not always be necessary to carry out a head–to–toe examination. The types of injury it is useful to identify include minor bleeds, bruising over internal organs that could indicate internal bleeding and deformities that could indicate fractures. It may also locate a medic alert tag that will help you be aware of a casualty’

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