First Aid

First Aid: Check & Call

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Check

Once you recognize an emergency you must first check the scene, then check the person.

Check the Scene

Before rushing to help an ill or injured person, stop and take a good look at the scene. This will form an initial impression.

Try to answer these questions

Is the scene safe for you, the ill or injured person, and any bystanders?

Enter a scene only if it is safe to do so. Look for hazards such as spilled chemicals, hostile bystanders, or oncoming traffic. Listen for things such as ringing alarms or leaking gas. Smell for things such as gas or smoke. Avoid entering confined areas with poor ventilation and places where there is a risk of explosion (e.g., from leaking propane or natural gas). Do not enter the scene if the person is hostile or threatening suicide.

If hazards are present, stay at a safe distance and call EMS/9-1-1. Leave dangerous situations for EMS personnel. Once EMS personnel arrive and make the scene safe, you can offer your assistance as appropriate. Remember that conditions at the scene may change, so a safe area could quickly become dangerous. It is important to continuously monitor your surroundings even if your initial assessment revealed a low level of risk.

What happened? How did it happen?

Take note of anything that might reveal the cause of the emergency. If the person is unresponsive and there are no witnesses, your check of the scene may offer the only clues as to what happened. Use your senses to detect anything out of the ordinary, such as broken glass, a spilled bottle of medication, or an unusual smell or sound. Keep in mind that the ill or injured person may not be exactly where he or she was when the emergency occurred—someone may have moved the person, or the person may have moved in an attempt to get help.

How many ill or injured people are there?

Look carefully for more than one ill or injured person. A person who is moving or making noise, or who has very visible injuries, will likely attract your attention right away, but there may be a person who is silent and not moving or a person obscured by debris or wreckage who you do not notice at first. It is also easy to overlook a small child or a baby.

Is there someone to help?

Take note of bystanders who can be of assistance. A bystander who was there when the emergency occurred or who knows the person may be able to provide valuable information. Bystanders can also assist in other ways, such as by calling EMS/9-1-1, waiting for EMS personnel and leading them to the site of the emergency, getting needed items (such as an AED and first aid kit), controlling crowds, and reassuring the injured or ill person.

What is your initial impression of the ill or injured person? Before you reach the person, try to form an initial impression about the person’s condition and what is wrong. For example, does the person seem alert, confused, or sleepy? Look at the person’s skin—does it appear to be its normal color, or does it seem pale, ashen (grey), or flushed? Is the person moving or motionless? Does the person have any immediately identifiable injuries? Look for signs of a life-threatening illness or injury, such as unresponsiveness, trouble breathing, or life-threatening bleeding.

Check the Person (Primary Assessment)

If it is safe to do so, quickly check the person to determine his or her initial condition and whether there are any life-threatening concerns. This is called the primary assessment.

1. Check the person to see if he or she is responsive

  • Does the person respond when you talk to him or her (e.g., does the person open his or her eyes, move, moan, or talk to you)?
  • Does the person respond when tapped on the shoulder? A person who does not respond at all is considered to be unresponsive.

2. Check the person’s ABCs: Airway, Breathing, and Circulation

Note: Checking the ABCs is a rapid assessment and should be done as quickly as possible.

A = Check the Airway

Your first job is to make sure the person has an open airway. The airway is the pathway that connects the mouth and nose to the lungs. If it is closed or blocked, air cannot get in. The airway is most commonly blocked by the tongue. If the person is speaking, moaning, or crying, the person’s airway is open.

If the person is unresponsive, perform a head-tilt/chin-lift. The head-tilt moves the back of the tongue away from the airway, and the chin-lift opens the epiglottis.

Performing the Head-Tilt/Chin-Lift

To perform a head-tilt/chin-lift, place one hand on the person’s forehead and 2 or 3 fingers under the chin. Gently tilt the head back until the chin is pointing upward.

B = Check Breathing

Next, check for breathing. Someone who can speak or cry is breathing. Check for normal breathing for 5 to 10 seconds. To assess breathing, put your cheek close to the person’s face so that you can hear and feel air coming out of the person’s nose and mouth while you watch the chest rising and falling. A person is breathing normally if the air is moving in and out of the lungs and the chest is rising and falling in a normal, regular pattern.

Agonal Respiration

A person who is not breathing normally may be occasionally gasping for air: this is a reflex action called “agonal respiration” and unlike normal breathing, it is irregular and sporadic. Because agonal respiration does not oxygenate the blood, it is not considered normal breathing. A person who is experiencing agonal respiration is in cardiac arrest and requires immediate assistance.

Agonal respirations originate from lower brainstem neurons as higher centers become increasingly hypoxic (oxygen-deprived) during cardiac arrest. With agonal respiration, the diaphragm is still receiving intermittent residual impulses from the brain, resulting in sporadic gasping breaths. Agonal respiration is sometimes referred to as “air hunger” and it can appear as snorting, gurgling, moaning or gasping, a gaping mouth, or labored breathing. The duration differs from person to person, lasting from a few minutes to hours.

C = Check Circulation

If the person is breathing normally (more than an occasional gasp), his or her heart is beating. Checking circulation means quickly looking at the person from head to toe for signs of life-threatening external bleeding. Life-threatening bleeding must be controlled as soon as possible.

Unresponsiveness, trouble breathing, and life-threatening bleeding are all signs of a life-threatening emergency. If your initial check of the person reveals any of these conditions, you must provide care for that condition immediately. Make sure that someone calls EMS/9-1-1 right away, and obtain an AED and first aid kit if these items are available.

Obvious Signs of Death

Obvious signs of death include

  • Torso transection (torso cut into two pieces)
  • Decapitation (detached head)
  • Decomposition

If you encounter a person with one or more of these signs, call EMS/9-1-1 and follow the dispatcher’s instructions. Leave the body and scene exactly as they were found, as the area could be considered a crime scene.

Rolling a Person from a Face-Down to a Face-Up Position

A person can collapse in a variety of positions. If a person is lying face down, is unresponsive, and not breathing, or if the face-down position makes it impossible to check the person’s ABCs, then the person must be rolled into a face-up position without delay.

Move an ill or injured person only if

  • The person’s position stops you from giving care for a life-threatening injury or illness.
  • The person is blocking access to someone with a more serious injury or illness.
  • The scene is becoming unsafe.

To roll a person from a face-down to a face-up position

  1. Support the head while rolling the person.
  2. Try to roll the person as one unit (head, back, and legs at one time).
  3. Open the airway with a head-tilt/chin-lift once the person is facing upward.
  4. Check the person’s ABCs.

Call

If you identify an unresponsive individual or an individual with a life-threatening condition in your initial check, you must always activate EMS.

If you identify an unresponsive individual or an individual with a life-threatening condition in your initial check, you must always activate EMS.

Whenever possible, use a mobile phone or ask a bystander to call EMS/9-1-1. Having someone else call is better than doing it yourself; this way, you can stay with the ill or injured person and continue to give first aid. If you are alone with the person and you do not have a mobile phone, call out loudly for help. If no one comes, get to a phone as quickly as you can and call EMS/9-1-1. As soon as you hang up, return to the person.

If someone else has to leave to make the call for you, ask that person to come back and tell you what the EMS/9-1-1 dispatcher said. If using a mobile phone, the person can stay with you while placing the call and speaking to the dispatcher.

NOTE: Any time you activate EMS, you should also obtain a first aid kit and an AED if they are available.

If You Are Alone: Call First or Care First?

If you are alone without a phone and there is no one to send to call EMS/9-1-1, you may need to decide whether to call first or give care first. Unless the situation specifically requires you to provide care before calling EMS/9-1-1, you should always activate EMS first so that help will arrive as soon as possible.

You should provide care first in the following situations

The person is choking or is experiencing anaphylaxis and carrying epinephrine.

In these cases, the person could die before EMS arrives, so providing immediate care is your highest priority. Moreover, these situations can be corrected by First Aiders, so immediate care may actually improve the person’s condition. If a person experiencing anaphylaxis is not carrying epinephrine, there is little that you can do as a First Aider, so you should call EMS/9-1-1 first before providing care.

The person has life-threatening bleeding

Life-threatening bleeding quickly reduces the body’s blood volume, which can be fatal. Apply direct pressure immediately, then call EMS/9-1-1 as soon as possible. In many cases, the person will be able to apply pressure to his or her own injury while you (or a bystander) call EMS/9-1-1.

The person is an unresponsive child or baby who is not breathing.

Children’s organs require high levels of oxygen in the blood to function efficiently and can rapidly shut down when oxygen levels are lowered. For this reason, cardiac arrest in children is more likely to be caused by low oxygen levels than by a problem with the heart itself. If you find a non-breathing child or baby who is unresponsive, you must introduce oxygen into his or her system as soon as possible. Immediately do 2 minutes of CPR (5 cycles of 30 compressions and 2 breaths) to increase the oxygen level, then quickly call EMS/9-1-1 before returning to provide more care.

When You Call EMS/9-1-1

When you call, the EMS dispatcher who answers will likely ask:

  • Where is the emergency (e.g., the address, nearby intersections, or landmarks)?
  • What is the nature of the emergency (i.e., is police, fire, or medical assistance needed)?
  • What telephone number are you calling from?
  • What is your name?
  • What has happened?
  • How many people are involved and what is their condition?

Don’t hang up until the dispatcher tells you to. The dispatcher may need more information. Many dispatchers are also trained to give first aid and CPR instructions over the phone, which can be helpful if you are unsure of what to do or need to be reminded of the proper care steps.

Radio Medical Advice in a Marine Environment

In a marine environment, it may not be possible for EMS personnel to come to your assistance in an emergency. You may need to contact a doctor and request advice on providing care, even if it is outside of your training. Document the doctor’s orders carefully.

Medical advice can be accessed by

  • Mobile phone.
  • Radiotelephone contact with a shore radio station.
  • Radiotelephone contact with a nearby port or ship with a doctor on board.

You should prepare the following information and present it to the doctor

  • Routine information about the ship
  • Routine information about the person
  • Details of the illness/injury
  • Findings from your secondary assessment
  • Care rendered and the person’s response to that care

For Example, Transport Canada provides a reference regarding radiotelephone procedures (TP 9878E: Safety and Distress Radiotelephone Procedures), which should be displayed next to your vessel’s radiotelephone. The procedures in this reference advise that safety and distress radio messages should be made on Channel 16 (156.8 MHz) or on frequency 2,182 kHz, MF.

President

The divine scriptures are God’s beacons to the world. Surely God offered His trust to the heavens and the earth, and the hills, but they shrank from bearing it and were afraid of it. And man undertook it.
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