TABLE

OFCONTENTS
Introduction,
1 I
Lesson
1: BeforeGivingCare,2 i.J
I
I

Lesson
2: Ghecking
anlll or IniuredPerson,
12
Lesson
3: BreathingEmergencies andGonscious
Ghoking-
Adult,Childor Infant,19
Lesson
4: RescueBreathing-Ghi
ld ot lnlant,22
Lesson
5: iac Emergencies,
Card 24
Lesson
6: GPR
andUnconscious
Ghoking-Adult,
Childor Infant,20
Lesson
7: AED-Adult,28
Lesson
8: AED-Child,
30
Lesson
9: SoftTissue
lnjuries,3l
Lesson
l0; Injuries
to Muscles,
BonesandJoints,39
Lesson
11: Sudden
lllness,4T
Lesson
12: Heat-andGold-Related
Emergencies,
51
Appendix
A: Anatomy
of a FirstAid Kit,53
Appendix
B: ChildandInfantSafety
Checklist,54
Appendix
C: lnjuryPrevention,56
Appendix
D: Incident
Stress,63
Appendix
E: Substance
Abuse,64
Appendix
F: SpecialSituations
andCircumstances,
65
Appendix
0: Asthma,
68
Appendix
H: Epinephrine
Auto-lnjector
7l
Appendix
l: Exams
andAnswerSheets,
75

i i I T a b i eo f C o n t e n t s
 AND
PRECAUTIONS
HEALTH morelikelyit isthatyoucanbeprovided
a sepa-
ratemanikin.
TRAINING
DURING
GUIDETINES
TheAmerican RedCross hastrained millions of GUIDETINES
t people infirstaidandcardiopulmonary resusci- In addition to taking theprecautions regarding
tation ( C P Ru)s i n g
m a n i k i nasst r a i n i nagi d s . manikins, y0ucanfurther protect yourself and
f TheRedCross follows widelyaccepted otherparticipants frominfection byfollowing
guidelines forcleaning anddecontaminating theseguidelines.
training manikins. lf theseguidelines are . Washyourhands thoroughly before partici-
adhered to,theriskof anykindof disease trans- patingin classactivities.
mission duringtrainingis extremely low . Donoteat,drink, usetobacco products or
Tohelpminimize theriskof disease trans- chewgumduring class.
mission, youshould followsomebasichealth . Clean themanikin properly before use.
precautions andguidelines whileparticipating in o Forsomemanikins, thismeans vigorously
training. Youshould takeprecautions if youhave wiping themanikin's faceandtheinside of
a condition thatwouldincrease yourriskor itsmouth witha clean gauze pad soaked
otherparticipants' riskof exposure to infections. witheithera freshsolution of liquidchlo-
Request a separate training manikin if you- rinebleach andwaterl\/acup sodium
. Haveanacutecondition, suchasa colda hypochlorite pergallon oftapwater)or
sorethroat, or cutsorsoresonthehands or rubbing alcohol. Thesurfaces should
your
around mouth. remain wetforat least1 minute before
. Knowy0uareseropositive (have hada posi- theyarewipeddrywitha second pieceof
tiveblood test)forhepatitis B surface antigen clean, absorbent material.
(HBsAg), indicating thatyouarecurrently o Forothermanikins, it means changing the
infected withthehepatitis B virus.* manikin's face.Yourinstructor willprovide
. Knowyouhavea chronic infection indicated youwithinstructions forcleaning thetype
bylong-term seropositivity (long-term posi- of manikin usedinyourclass.
tivebloodtests)fortheHBsAg" or a positive . Follow theguidelines fromyourinstructor
blood testforanti-human immunodeficiency whenpracticing skillssuchasclearing a
virus(HlV)[thatis,a positive testfor anti- blocked airway withyourfinger.
bodies to HIVthevirusthatcauses many
severe infections including acquired immun- PHYSICAT STRESS ANDINJURY
odeficiency syndrome (AIDS)1. S u c c e s s fcuolu r s ceo m p l e t i roenq u i r ef us l l
. Havehada positive bloodtestfor hepatitis C. participation in classroom andskillsessions, as
. Havea condition thatmakes youunusually w e l la ss u c c e s s fpuel r f o r m a ni cne s k i lal n d
likely to getaninfection. knowledge evaluations. Youwillbeparticipat-
Toobtain information about testing for indi- ingin strenuous activities, suchas performing
vidualhealth status, visittheCDC Websiteat CPRonthefloor.lf you havea medical condi-
www.cdc.gov/nc idod/d iseases/h epatitis/clf aq.htm. tionor disability thatwillprevent youfromtak-
lf youdecideyoushouldhaveyourown ingpartintheskillspractice sessions, please
manikin, askyourinstructor if heor shecan let your instructor knowsothataccommoda-
provide oneforyouto use.Youwillnotbeasked tionscanbemade. lf youareunable to partici-
to explain whyinyourrequest. Themanikin will pate fullyinthecourse, may you "audit" the
notbeusedbyanyone elseuntilit hasbeen c 0 u r s ae n dp a r t i c i p aat sem u c ha sy 0 uc a no r
t ogt h er e c o m m e n deendd - o f - desire.
c l e a n eadc c o r d i n Toaudita c0urse, youmustletthe
classdecontamination procedures. Because the instructor knowbefore thetraining begins. You
number of manikins available forclassuseis w i l ln o fb ee l i g i b lt eo r e c e i vaec o u r s ceo m p l e -
limited, themoreadvance notice yougive,the tioncertificate.
*A personwith a hepatitisB infectionwilltest positivefor the HBsAg.MostpersonsinfectedwithhepatitisB will get befterwithina periodof tine. How'
eve4in somepeoptehepatitisB infectionswill becomechronicandwill lingerfor muchlonger Thesepersonswill continueto testpositivefor HBsAg.
Theirdecisionto participatein CPBtrainingshouldbe guidedby theirphysician. After a personhashadan acutehepatitisB infection,he or shewill no
longertestpositivefor the surfaceantigenbut will testp\sitive for the hepatitisB antibody(anti-HBs).
Personswhohavebeenvaccinatedfor hepatitisB
A positivetestfor anti-HBsshouldnot be confusedwith a positivetestfor HBSAG.
will alsotestpositivefor the hepatitisantibody.

l n t r o d u e t i ol n
"!
BEFORE
GIVING
CARE
r-
RECOGNIZING
ANDRESPONDING . Being
familiarwith
GoodSamaritan
laws
TOAN EMERGENCY andobtaining
consent.
Emergencies areoftensignaled by
something unusual thatcatches GOODSAMARITAN
LAWS
yourattention, suchas- ANDOBTAINING
CONSENT
. Unusual sights.
. U n u s ua pl p e a r a n coer s GoodSamaritanLaws
All50states haveenacted GoodSamaritan laws
behaviors.
. U n u s uoadl o r s . thatgivelegalprotection to peoplewhowillingly
. U n u s unaol i s e s . giveemergency careto anillor injured person
withoutaccepting anything in return.These
It maybehardto recognize an
laws,whichdifferfromstatet0 state,usually
e m e r g e nocrys u d d einl l n e si sn
protectcitizenswhoactthesamewaythata
somecases. Thesignals arenot "reasonable
alwayseasyto seeor identify. andprudent person" wouldif that
. lf youthinksomething personwereinthesamesituation.
iswrong,
Developed to encourage people to help,
checktheperson. Askques-
tions.0uestions
theselawsrequire the"GoodSamaritan" to-
mayhelpyou . Actin goodfaith.
findoutwhatiswrong. . Notbedeliberately
. A person negligent or reckless.
maydenyanything is . Actwithinthescopeof hisor hertraininE.
seriously wrong. . Notabandon theperson afterstartingto
givecare.
OVERCOMING
BARRIERS
TOACT Youshould contact a legalprofessionalor
Sometimes,eventhough people recognize that checkatthelocallibrary to findoutmoreabout
anemergency hasoccurred, theyfailto act.The yourstate'sGoodSamaritan laws.
mostcommon factors thatkeeppeople from
respondingare- 0 b t a i n i n gG o n s e n t
. Thepresence of otherpeople. Before giving firstaidto a conscious adult,you
. Beingunsure oftheill or injured mustobtain
person's hisor herpermission to givecare.
condition. Thispermission is referred to asconsent. A con-
. Thetypeof injuryor illness. scious person hastherightto eitherrefuse or
. Fearof catching a disease. a c c e pcta r e .
. Fearof doingsomething wrong. Toobtain consent-
. Fearof beingsued. 1. Stateyourname.
. Being 2. Telltheperson
u n s u roefw h e nt o c a l l g - 1 - 1 . youaretrained infirstaid.
3. Asktheperson if youcanhelp.
Waysto Overcome Barriers to Act 4. Explain whatyouthinkmaybewrong.
. Getting
trainedinfirstaid,cardiopulmonary 5. Explain whatyouplanto do.
(CPR)
resuscitation or howtouseanauto- lmportant points to remember include-
matedexternal (AED).
defibrillator . D0 NOTgive.care to a conscious person
o Training
to developtheconfidenceto act, whoreluses it.
whichenables youto takecharge until . lf a person doesnotgiveconsent, youshould
moreadvanced helparrives. stillcall9-l-1orthelocalemergency number.
. Avoidingcontactwithbloodor bodyfluids . lf theconscious person is aninfantor child,
byusingprotectivebarriersandfollowing getpermission to givecarefromtheparent
standardprecautions. or guardian if present.

? I FirstA"i/*PAlAfn fr:rthe l{l::rkpla*eParricipant's

Workbonk
 l f t h ep e r soins u n co n sci ooursu n a b lto
e o Disposable ( nitr ile
gloves orvinyl)
o r i n j u ry,
r e s p o nddueto th ei l l n e ss co nsent . Gloves withbloodareconsidered
soiled
l mp
i si m p l i e d . l i eco
d n se nmet a nyo s ucan anda "biohazard,"
contaminated and
assume thatif theperson couldrespond, he bedisposed
should (Fig.
of properly 1-3).
or shewouldagreeto becaredfor.
C o n s e instal soi mp l i efo
d ra ni n fa not r child
I
x if a parent or guardian is notpresent or
I i m m e d i a te a lva
y ilable.

PREVENTING
DISEASE
TRANSMISSION
Theriskof getting a disease whilegiving firstaid Bepr epar ed byalways having a pr oper l y
is extremely low.Whenyoufollowstandard pre- equipped fir staidkitnear by. ( SeeAppendiAx,
cautions, youcanreduce thatriskevenfurther. Anatomy of a FirstAidKit,for a detailed listof
Alwaysgivecareinwaysthatprotect youand r equir ed item s.)
theperson fromdisease transmission.
Wheneve por ssi b lyo e , ush o u l d - C l e a n i nUgpa B l o o dS p i l l
a Avoid contactwith andotherbodyfluids. lf a blood
blood spilloccur s-
a Avoid touching objects thatmaybesoiled . Clean upthespillimm ediately or assoonas
withbloodor otherbodyfluids. possible afterthespilloccurs.
Cover anycuts,scrapes or sorespriorto put- . Usedisposable gloves andotherper sonal
tingonprotective equipment, suchasgloves. pr otective equipment whencleaning spil l s .
Remove jewelrysuchasringsandwatches . Wipeupthespillwithpapertowelsor other
beforegivingcare. absor bent m ater ial.
Avoideating; drinking; smoking; applying . Aftertheareahasbeenwipedup,floodthe
or l i pb a l m;
c o s m e t i cs h a n d l i ncog n ta ct ar eawitha solution of 11lzcupof liquid
l e n s e so;rt o u ch i nyog u rmo u thn,o seor chlor ine bleach to 1 gallon offr eshwate r
eyeswhenyoumaybeexposed to infec- ( 1par tbleach per10par tswaterand ) all ow
tiousmaterials or giving firstaid. it to standfor at least10minutes.
Placebarriers between youanda person's . Dispose ofthecontaminated mater ialus ed
b l o o do r o th e br o d yfl u i d su si n gsu ch to cleanupthespillin a labeled biohaz ar d
itemsas- container ( Fig.
1- a) .
o Protective eyewear (Fig.1-1).
o CPRbreathing barriers (e.9., resuscitation
(F
m a s kos rfa cesh i e l d s) 1 -2 ).i g .

0SHAStandards
pr ecautions
Univer sal ar ethefeder al
0ccup a-
tionalSafetya'ndHealthAdministration's(0SHA)
requiredpracticesof infection protect
controlto
employees fromexposure to bloodandother
potentially mate
infectious rials.Theseprecau-
e allhum an
tionsr equirthat bloodandcer tai n
bodysubstances betreated asif knownto be

* n f c r * S i v i n g* a r * | 3
 l f t h ep e r soins u n co n sci ooursu n a b lto
e o Disposable ( nitr ile
gloves orvinyl)
respond dueto theillness or injury, consent . Gloves withbloodareconsidered
soiled
l mp
i si m p l i e d d n se nme
. l i eco t a nyos ucan anda "biohazard,"
contaminated and
assume thatif theperson couldrespond, he bedisposed
should (Fig.
of properly 1-3).
i
or shewouldagreeto becaredfor.
C o n s e instal soi mp l i efo
d ra ni n fa not r child
t if a parent or guardian is notpresent or
I
I i m m e d i a te a lva
y ilable.

PREVENTING
DISEASE
TRANSMISSION
Theriskof getting a disease whilegiving firstaid Beprepared byalwayshaving a properly
is extremely low.Whenyoufollowstandard pre- equipped fir staidkitnear by. ( SeeAppendiA, x
cautions, youcanreduce thatriskevenfurther. Anatomy of a FirstAidKit,for a detailed listof
Alwaysgivecareinwaysthatprotect youand r equir ed item s.)
theperson fromdisease transmission.
Wheneve por ssi b lyo e , ush o u l d - C l e a n i nUgpa B l o o dS p i l l
a Avoid contactwith andotherbodyfluids. lf a bloodspilloccur s-
blood
a Avoid touching objects thatmaybesoiled . Clean upthespillimm ediately or assoonas
withbloodor otherbody fluids. possible afterthespilloccurs.
Cover anycuts,scrapes or sorespriorto put- . Usedisposable gloves andotherper sonal
tingonprotective equipment, suchasgloves. pr otective equipment whencleaning spil l s .
Remove jewelrysuchasringsandwatches . Wipeupthespillwithpapertowelsor other
beforegivingcare. absor bent m ater ial.
Avoideating; drinking; smoking; applying . Aftertheareahasbeenwipedup,floodthe
or l i pb a l m;
c o s m e t i cs h a n d l i nco
g n ta ct ar eawitha solution of 11lzcupof liquid
l e n s e so;rt o u ch i nyog u rmo u thn,o seor chlor ine bleach to 1 gallon offr eshwate r
eyeswhenyoumaybeexposed to infec- ( 1par tbleach per10par tswaterand ) all ow
tiousmaterials or giving firstaid. it to standfor at least10minutes.
Placebarriers between youanda person's . Dispose ofthecontaminated m ater ial
us ed
b l o o do r o th ebr o d yfl u i d su si n gsu ch to cleanupthespillin a labeled biohaz ar d
itemsas- container ( Fig.
1- a) .
o Protective eyewear (Fig.1-1).
o CPRbreathing barriers (e.9., resuscitation
(F i
m a s kos rfa cesh i e l d s) 1 -2 ). g .

0SHAStandards
pr ecautions
Univer sal ar ethefeder al
0ccup a-
tionalSafetyahdHealth Administration's(0SHA)
requiredpracticesof infection protect
controlto
employees fromexposure to bloodandother
potentially mate
infectious rials.Theseprecau-
e allhum an
tionsr equirthat bloodandcer tai n
bodysubstances betreated asif knownto be

* * l c r * S i v i n g* a r * I 3
 infectious for hepatitis B virus,hepatitis Cvirus, 2. CAtt9- 1- 1orthelocalem er genc y ber
num
h u m a inm mu n o d e fi ci evinru cys(H l V(the) vir us whenappr opr iate. Calling for helpis often
t h a tc a u s eascq u i rei mmu
d n o d e fi ciency
syn- themostimpor tant action youcantak eto
drometAlDSl) or otherbloodborne pathogens. helpanill or injur ed per son whone eds
Otherapproaches to infection control arecalled car e.lt willstar tem er gency m edical c ar e
standard precautions andBodySubstance lsola- on itswayasfastaspossible.
t i o n( B S lp) re ca u ti o Tn s.
h e sep re ca utions mean 3. CARE fortheill or injured person.
t h a ty o us h o u lcod n si d earl lb o d yfl u i dsandsub- lf youareALONE-
stances asinfectious. . C a lF l i r s(tc a l l 9 - 1o- 1
r t h el o c ael m e r -
Togeta copyofthe0SHABloodborne gencynum berbefor ) giving
e car efor -
P a t h o g eS n sta n d a (C
rd F R
1 9 1 0 .1 0o30) rformor e o Anunconscious adultor adole s c ent age
information onthestandard, referto OSHA'S 12year sor older .
Websiteat www.osha.gov. o A witnessed sudden collapse of a c hi l d
Tolearnmoreaboutreducing yourriskofdis- or infant.
easetransmission, consider enrolling intheAmer- o Anunconscious infant or childk now n
icanRedCross Bloodborne Pathogens Training: to beat a highriskfor heartproblems.
Preventing Disease Transmission course. . CareFirst(give2 minutes of care), thencall
9- 1- or
1 thelocalemer gency num ber for -
o Anunwitnessed collapse of anunc on-
EMERGENCY
ACTION
STEPS scious per son younger thanl2 year s
In anyemergency, always followthreeemer- old.
gencyactionsteps. Following thesestepscan " Anyvictimof a drowning.
m i n i m i zt he
e co n fu si oant a ne me rg ency scene. GallFirstsituations arelikely to becardiac emer-
1. CHECK thesceneforsafety; CHECK theill or gencies, suchassudden cardiac arrestor a wit-
injured person. nessed sudden collapse of a child, inwhic hti m e
. GHECK thescene: is critical, Research showstheshorter thetime
o ls it safe? fromwhena person collapses to whenCpRis
" W ha th a p p e n e d ? initiated andwhenheor sheis giventhefirst
o H o wma n yp e o p laerei n vo l ved? shockwithanautomated external defibrillator
o l st h e rei mme d i adte a n g ei rn volved? (AED), thegreater thechance of survival foran
o l s a n yo neel sea va i l a bto
l eh e lp? adultor child1yearoldor older. InGareFirstsit-
. GHECK for life-threatening conditions, uations, theconditions areoftenrelated to
s u c ha s- br eathing em er gencies.
" U n co n sci o u sn e ss.
o Nobreathing ortroublebreathing.
o Nosignsof life(breathing or move-
ment).
o S e ve re bleeding.

4 | F i r s tA i d l C f R l ADf f * r ' t h sV / c r k p l a cf*a r r i ei n a n r ' W

s crkirs0k
 l f t h ep e rsoins u n co n sci ooursunable to o Disposable ( nitr ile
gloves orvin y l )
respond dueto theillness or injury, consent . Gloves withbloodareconsidered
soiled
l mp
i s i mp l i e d . lied co n se me
n t ans you can anda "biohazard,"
contaminated and
a s s u me th a ti f th ep e rsoco n u l dr espond, he bedisposed
should of properly (Fig.1-3).
or shewouldagree to be cared for.
C o nse insta l soi mp l i efo d ra ni nfant or child
ifa p a re nort g u a rd i a
isnn o tp resent or
i m me d i a te a lva
y ilable.

DISEASE
PREVENTING
TRANSMISSION
Theriskof getting a disease whilegiving firstaid Bepr epar ed byalways having a pr oper l y
is extremely low.Whenyoufollowstandard pre- equipped firstaidkitnearby. (SeeAppendix A,
cautions, youcanreduce thatriskevenfurther. Anatomy of a FirstAidKit,for a detailed listof
Alwaysgivecareinwaysthatprotect youand r equir ed
items.)
theperson fromdisease transmission.
Whenever possible, youshould- C l e a n i nUgpa B l o o dS p i l l
. Avoidcontactwith blood andotherbodyfluids. lf a blood spilloccur s-
. Avoidtouching objects thatmaybesoiled . Clean upthespillim m ediately or ass oonas
withbloodor otherbodyfluids. possible afterthespill occur s.
. Cover anycuts,scrapes or sorespriorto put- . Usedisposable gloves andotherper s onal
tingonprotective equipment, suchasgloves. pr otectiveequipm ent cleani ng
when s pi l l s .
. Remove jewelrysuchasringsandwatches . Wipeupthespillwithpapertowelsor other
b e fo re g i vi n g
ca re . absor bent mater ial.
. A v oi de a ti n gd;ri n ki n g ;smo king; applying . Aftertheareahasbeenwipedup,floodthe
c o sme ti cs h a n d l i ng
o r l i pb a l m; contact ar eawitha solution of lllzcupof l i qui d
o rto u ch i nyo
l e n se s; g u rmo u th, noseor chlor ine bleach to 1 gallon offr eshw ater
eyeswhenyoumaybeexposed to infec- ( 1par tbleach per10par tswater)andal l ow
tiousmaterials or giving firstaid. ittostand forat least10m inutes .
. Placebarriers between youanda person's . Dispose ofthecontaminated material used
b l o o do r o th e br o d yfl u i d su si ng such to cleanupthespillin a labeled bi ohaz ar d
itemsas- container ( Fig.
1- a) .
o Protective eyewear (Fig.1-1).
o CPRbreathing barriers (e.9., resuscitation
m a sks (F i g
o rfa cesh i e l d s) 1- 2) . ,

0SHAStandards
Univer salpr ecautions ar ethefeder al
0c c upa-
tionalSafetyandHealth Administration's(0SHA)
required practices of infectioncontroltoprotect
employees fromexposure to bloodandother
potentiallyinfectiousmateri als.Theseprecau-
e allhum an
tionsr equirthat bloodandc er tai n
bodysubstances betreated asif knownto be

: i v i n gi l n r * I 3
S e f o r rG
Whento Gall9-1-1-Adult Note:The conditions listedabovearenota com-
pletelistof life-threateningconditionsandthere
D i r e c t io nP s:l a cea ch e ckmairk nthebox
in which arealwaysexceptions. lf youareconfused or
n e x t o a n yl i fe -th re a te nco i n gn d i tions
unsurabout
e orthel oc al
whatto do,call9- 1- 1
9-1-o 1 rt h el o c ael m e r g e nnc u y m b esrh o u l d
b ec a l l e d . em er gency num ber .

n M i no b r ru i se o nth ea rm W h e nt o C a l l9 - 1 - l - C h i l da n dI n f a n t
X U n co n sci o u sn e ss Place
Directions: a checkmarkintheboxnextto
n Trouble breathing or breathing in a strange anylife-threatening in
conditionswhich9-1-1 or
way thelocalem er gency should
num ber bec al l ed.
n Abrasion ontheelbow I Minorbr uise onthear m
n Notbreathing n S u d d esni l e n c e
I C u tl i p n A catscr atch onthecheek
! Nosignsof life n Child foundatthebottom of a pool w i thno
I Persistent chestpain signsof life
n Severe bleeding thatdoesnotstop n Notbreathing
o nth esh o u l d e rs n Bleeding fr omthekneethatcannot be
t r M i l dsu n b u rn
controlled
! C r a mp i nth eth i g h
n Deepbur nontheface
n D e epb u rnto th efa cea n dn e ck
rer p a i ni nth ea b d o men thatdoes Note:The conditions listedabove ar enota c om -
n Pr e ssu o
notg0away pletelistof life-threatening
conditions andthere
arealways exceptions.lf youareconfused or
I Vomiting bloodor passing blood
unsurabout
e whatto do, 9-
call 1- or
1 thel oc al
X M u l ti p lse e i zu reosr se i zu rethat s lastlonger em er gency number .
t h a n5 mi n u te s
orthelocalemergenc
Also,call9- 1- 1 num
y -
T Po s si bhl ee a dn, e cko r b a cki n jur ies berif anyofthefollowing conditions exist:
tr A p pa re n p to i so n i n g . Fir eor explosion
n Sp li n tei nrth efi n g e r . Thepr esence of poisonous gas
n Broken armwithboneshowing through the . Downed
. Swiftly moving or
wir es
electr ical
rapidlyrisingwater
skin
. M otorvehiclecollisions
tr Su dd ese n ve re h e a d a choer sl ur r edspeech
. Per sons whocannot bem oved ea s i l y
n Bloody nose

* * f * r * S i v i n gi l * r * 1 S
 CALLING9-1.1 ORTHELOCATEMERGENCY
NUMBER
Instructions
for Emergency INFORM ATION FOREM ERGENCY C Att
TelephoneGalls Bepreparedto give thisinfornation to the
emeryencymedicalseruices(EMS)dispatcher.
EMERGENCY
TETEPHONE
NUMBERS
(Dial 1. Location:
for outsideline)
. Streetaddress:
EMS:
. Cityor town:
Fire:
. Directions
(cross
streets,
roads,
land-
Po l i c e :
marks,etc.):
. Exitsandevacuation
routes:
Poison Center:800-222-1222
Control
N u m b er
ofth i ste l e p h o n e : Telephone
num ber
fr omwhichthec al li s
beinm
g ade:
OTHER
IMP OR T A N
TTE T E P H ONE
NUMBERS
3. Callername:
's
F a c i l i tma
y n a g e r:
4. W hathappened?
F a c i l i tma
y i n te n a n ce :
5. Howmanypeople
ar einjur ed?
Po w ecr omp a n y:
6. Condition person(s):
of injured
G a sc o m p a n y:
7. Help( car e)
beinggiven:
W e a t h er
b u re a u :
Note:
N a m ea nda d d re ss
o f me d i cafal ci l ity
with . Donothangup first.LettheEMSdispatcher
24-hour emergency cardiac care: hangup first.
. ln citieswithEnhanced g-l-l (Eg-l-l) sys-
tems,it is stillimportantto knowtheinfor-
mationabovefor communication to the
dispatcher. ln manybuildings,the telephone
systemmayconnectthrough a switchboard
thatwill showonlythe corporateaddress
ratherthanthespecificfacilityfromwhich
youare calling.Withmobiletelephones,
E 9-l-l is notfunctionalbecause thereis no
fixedlocationto identifyon the dispatcher's
screen,so sharingthisinformation is the
onlywayto provideit.
. Thissampleformcanbepostedby thetete-
ooo:

S I F i r s tA i d / ff n / A E Sf o r r h e W c r k p l a * :pea r t i c i p a n r\.rsV a r k b * * k
 Whento Gall9-1-l-Adult Note:The conditions listed above ar enota c om -
D i r e c t io nPs:l a cea ch e ckmairk nthebox pletelistof life-threatening conditions andthere
n e x t o a n yl i fe -th re a te nco i n gn d i tions
in which arealwaysexceptions. lf you areconfused or
9-1-1 o rt h el o c ael m e r g e n nc u y m b esrh o u l d u n s u raeb o u t w h a tdt oo ,c a l l 9 - 1 o
- 1r t h el o c a l
b ec a l l e d . emer gency number .
I M i n ob r ru i se o nth ea rm W h e nt o C a l l9 - 1 - l - C h i l da n dl n f a n t
I U n co n sci o u sn e ss Directions:
Place a checkmarkintheboxnextto
I Trouble breathing or breathing in a strange anylife-threatening conditions
inwhich9-1-1 or
way thelocalemer gency numbershould bec al l ed.
I A b r a si oonnth ee l b o w I M inorbr uise onthear m
I N o tb re a th i n g f S u d d esni l e n c e
I C u tl i p I A catscr atch onthecheek
I Nosignsof life tr Childfoundatthebottom of a poolwithno
I Persistent chestpain signsof life
I Severe bleeding thatdoesnotstop I Notbreathing
I M i l dsu n b u rn o nth esh o u l d e rs n Bleeding fr omthekneethatcann ot be
contr olled
I C r a mp i nth eth i g h
n D e epb u rnto th efa cea n dn e ck n Deepbur nontheface
n Pr e ssu o rer p a i ni nth ea b d o men thatdoes Note:Theconditions listedabovearenota com-
notgoaway pletelistof life-threatening conditions andthere
bloodor passing arealways exceptions. lf youareconfused or
tr Vomiting blood
u n s u raeb o u t w h a tdt oo ,c a l 9
l - 1 - o1 r t h el o c a l
n M u fti p lse e i zu reosr se i zu rethats lastlonger em er gency number .
t h a n5 mi n u te s
n Po ssi bhl ee a dn, e cko r b a cki n jur ies A l s oc, a l 9
l - 1 - o1 r t h el o c ael m e r g e nncuym -
berif anyofthefollowing conditions exist:
tr A p pa re n p to i so n i n g . Fir eor explosion
n S p li n tei nrth efi n g e r . Thepr esence of poisonous gas
tr Broken armwithboneshowing throughthe . Downed
. Swiftly
electr ical wir es
skin moving or rapidly risingwater
. M otorvehicle
tr S u dd ese n ve re h e a d a choer sl ur r edspeech
. Per sons whocannot
collisions
bemoved eas i l y
tr Bloody nose

$
j-
t ffi*i*xrSl'.ring
ill** I $
;
I
9-1-1andE 9-1-1Systems Because mobile location
9- 1- 1 infor m atiion s
Therearetwotypesof9-1-1systems-Basic and notavailable everywhere, it is important to
Enhanced. A Basic9-1-1 system automatically r em ember the following tips whenusi nga
routes theemergency calltothePublic Service mobile phone to call9- 1- 1.
(PSAP)that . Tellthe call takerthelocation oftheemer-
Answering Point handles thearea
wherethephone is located. AnEnhanced 9-1-1 gency rightaway.
. Givethecalltakeryourwir eless p hone num -
system automatically displays thetelephone num-
ber,address andnameinwhichthephone is bersothatif thecall gets disconnected, he
listed. lf thecalleris unable to remain ontheline or shecancallyouback.
. lf yourwir eless phone is not"initi al i z ed"
or is unable to speak or if thecallisdisconnected,
thedispatcher canstillobtain enough information {i.e.,youdonothavea contract forservice
to sendhelp.Some9-1-1 systems canreconnect a with a wireless service provider) andyour
em er gency callgetsdisconnected, y oum us t
callerandtransfer callers to otheragencies or
telephone numbers witha single button. call the emer gencyoper atorbac kbec aus e
heor shedoesnothaveyourtele phone
l n f o r ma ti o nL i n e number andcannot contact you.
. Lear to n usethedesignated number i ny our
M a n y9 - 1 -1 ca l l si nth eU n i teS d ta tes ar enot
e m e r g e n ciF eos.rth i sre a so nso , mecitieshave statefor highway accidents or othernon-
s t a r t eudsi n g 3 -1 -1 (o rsi mi l a a
r)sa number for life-threatening incidents. States often
p e o p lteo ca l fol rn o n -e me rg esi tuations,
n cy Find reserve specific numbers for these typesof
incidents. Forexample , "#77" isthenumber
outif yourareausesthisnumber. Remember,
yourlocalemergency number isforjustthat- used for highway accidents in Vir gi niT a.he
e m e r g e n ci e Ss!op l e a se u seg o o di udgment. number to callfornonlife- thr eateni i ncngi-
dentsinyourstatecanbelocated inthe
Wireless 9-1-1 : Hundreds frontofyourphonebook.
. Donotpr ogr am yourphone to autom ati -
of MillionsServed
c a l l yd i a 9
l -1-1w h e no n e b u t t o snu c ha s
the"9" keyis pr essed. Unintenti onal w i r e-
less9- 1- 1calls,whichoftenocc ur w hen
autodial keysar einadver tentp lryes s ed,
cause oblemfor
pr s em er gencs yer v i c e
callcenter s.
. lf yourwir eless phone camepr epr o-
gr amm ed withtheauto- dial 9- 1-1 featur e
Mobilephones arenotassociated withonefixed already turned on,turn this feature off.
location or address, whichcanmakeit difficult Check youruserm anual to findou thow ,
to accurately determine thelocation ofthecaller . Lock your keypad when you arenotusing
ortheemergency. Current andfuturedevelop- yourwir eless phone. Thisaction al s opr e-
mentofthe9-1-1system includes initiativesto ventsaccidental callsto 9- 1- 1.
integ ratewireless technology moreeffectively. Sources:
T h eF e d e ra Clo mmu n i ca tiCoonmm s ission has DISPATC H MonthlyMagazine,
adopted a variety of 9-1-1rulesaimedat improv- www.91 | dispatch.com. Accessed 6124104.
ingthesystem's abilityto locatemobile 9-1-1 Feder al Com m unications Comm iss i on,
c a l l e r sT.h e se
ru l e sa p p l yto a l lmobile phones wwwfcc.gov/91 l/enhanced. Accessed 6/24104.
l i c e n s e ebs,ro a d b a n pd
e rso n co a l mm unication National Em er gency Num ber Assoc i ati on,
s e r v i c easn dce rta isp n e ci amo l b i le r adio www.hena.org. Accessed6124104.
l i c e n s e e s.

H e f c r eG i v i n gC a r e | 7
REACHING ANDMOVING
AN ILLORINJURED
PERSON
"DoNoFurther
Harm"
0 n eo ft h emo std a n g e roth u sre a ts
to a ser iously
i n j u r epde rsoins u n n e ce ssamo ry v ement,
Usu-
a l l yw h e ng i vi n ca
g reyo , uw i l ln o tfacedanger s
thatrequire youto movea person. In most
c a s e s, yo uca nfo l l o wth ee me rg ency steps
(CHECK-GALL-CARE)where youfindtheper-
s o nC . al l i nfo
g rh e l pi sth emo sti mpor tant step PACK-STRAP CARRY
y o uc a nta kei n a ne me rg e nto cyh elptheper son Tom oveeither a conscious or uncons c i ous
i n n e e dof ca re , person-
Moving . Position yourself withyourbackto the
a seriously injured person cancause
additional injuryandpainandcomplicate theper- per s0n.
son'srecovery. Therefore, youshould . Cross theperson's armsinfrontofyouand
movea per-
sononlyunderthefollowing threesituations: grasp the person's wrists.
1 . W h e nyo ua refa ce dw i thi mmediate danger . Leanfor war slightly
d andpulltheper s on
2. Whenyouhaveto getto another person who onto your back ( Fig.1- 6) .
mayhavea moreserious injuryor illness
3 . W he nyo un e e dto p ro vi dpero per car e
0nceyoudecide thatyoumustmovea per-
sonbased ontheguidance above, youmust
quickly decidehowtomove theperson. Carefully
consider yoursafety andthesafety oftheperson.
Ba s ey o u rd e ci si oonnth ed a n g e you rs ar efacing,
thesizeandcondition oftheperson, yourability
andcondition andwhether youhaveanyhelp.
Toavoidinjuring yourself ortheperson, use
y o u rl e gs,n o tyo u rb a ck, w h e nyo ubend. Bend
a tt h ek ne e a s n dh i p sa n da vo i d tw istingyour TW O.PERSON SEATCARRY
body. Walkforward whenpossible, takingsmall Tocar r ya per sonwhocannot walkandhasno
s t e p sa ndl o o ki nwgh e reyo ua reg oing. suspected head, neckor backinjur y-
Avoidtwisting or bending anyone witha . Putonear mundertheper son'thi s ghs
p o s s i bh l ee a dn, e cko r b a cki n j u ry. Donotm ove andtheotheracr oss theper son's bac k .
a person whoistoolargeto movecomfortably. . Interlock yourarmswiththoseof a second
r esponder under theper son'leg s sand
Emergency Moves acr oss theper son' s
back ( Fig.1- 7 A) .
. Lifttheperson in the "seat" formed bythe
W A T KIN A GS S IS T
T oh e l pa p e rsow n h on e e d a r esponder s' (
ar m s 1Fig. - 78) .
s ssi stance walking
to safety- . Move the person to
. Pl a ce th ep e rso na'srma cro ss yourshoul- safety.
d e r sa n dh o l di t i n p l a cew i tho nehand
( F i g.
1 -5 A ).
. Support theperson withyourotherhand
around theperson's waist.
. Movetheperson to safety.
A s e co nre d sp o n d e i fr,
p re se nt,c ansuppor t
theperson inthesamewayontheother
s i d e(F i g1. -5 8 ).

$l F i r i;i& i d i i l ffi l ,e i li **r'i h * !'V *r kpl***

il*r ii*lp*nt'* !'1"1*rhh**k
9-1-1andE 9-1-1Systems Because mobile location
9- 1- 1 infor m atiion s
Therearetwotypesof9-1-1systems-Basic and notavailable everywhere, it is important to
Enhanced. A Basic9-1-1 system automatically r em ember the following tips when usi ng a
routes theemergency callto thePublic Service mobile phone to call9- 1- 1.
. Tellthe calltakerthelocation oftheemer-
Answering Point(PSAP) thathandles thearea
gencyrightaway. '
wherethephone islocated. AnEnhanced 9-1-1
. Givethecalltaker yourwir elesphone s num -
system automatically displays thetelephone num-
ber,address andnameinwhichthephone is bersothatif thecall gets disconnected, he
listed. lf thecalleris unable to remain ontheline or she can callyou back.
or is unable to speak or ifthecallisdisconnected, . lf yourwireless phoneis not"initialized"
thedispatcher canstillobtain enough information (i.e.,
youdonothavea contract forservice
to sendhelp.Some 9-1-1 systems canreconnect a with a wireless service provider) andyour
callerandtransfer callers to otheragencies or emergency callgetsdisconnected, youmust
telephone numbers witha single button. calltheemer gency oper ator bac kbec aus e
heor shedoesnothaveyourtel ephone
lnformation Line num ber andcannot contact you .
. Lear to n usethedesignated num ber i ny our
M a n y9 -1 -1 ca l l si nth eU n i teS d tates ar enot
e m e r ge n ciF eo
s.rth i sre a so nso , mecitieshave state for highway accidents or other non-
s t a r t edu si n g
3 -1 -1 (o rsi mi l aar)sa number for life-threatening incidents. States often
p e o p lto e ca l fo
l rn o n -e me rg esituations.
ncy Find reserve specific numbers for these typesof
o u ti f y o u ra re au se sth i sn u mb er Remember
. , incidents. Forexample , "#77' isthenumber
y o u rl o cael me rg e nncy u mb ei sr forjustthat- used for highway accidents in V i r gi niTa.he
e m e r ge n ci e op l e a se
Ss! u seg o o djudgment. num ber to callfornonlife- thr eateni i ncng
i-
dentsinyourstatecanbelocated inthe
Wireless 9-1-1: Hundreds frontof yourphonebook.
of MillionsServed . Donotpr ogr am yourphone to autom ati -
callydial9- 1- 1 whenonebutton s uc has
the"9" keyis pr essed. Unintenti onal w i r e-
less9- 1- 1calls,whichoftenoc c urw hen
autodial keysar einadver tenpr tl yes s ed,
cause pr oblems for em er gen cs yer v i c e
callcenter s.
. lf yourwir eless phone camepr e pr o-
grammed withtheauto-dial 9-1-1 feature
Mobilephones arenotassociated withonefixed already turnedon,turnthis feature off.
location or address, whichcanmakeit difficult Check youruserm anualto findo uthow .
to accurately determine thelocation ofthecaller . Lock your keypad when you arenotusing
ortheemergency. Current andfuturedevelop- yourwireless phone. Thisactionalsopre-
mentofthe9-1-1system includes initiativesto vents accidental calls to 9- 1- 1.
integratewireless technology moreeffectively. Sources:
T h eF e d e ra Clo mmu n i ca tiCoonmm s ission has DISPATC H Monthly Magazine,
adopted a variety of 9-1-1rulesaimedat improv- www.91 | dispatch.com. Accessed 6124104.
ingthesystem's ability to locatemobile 9-1-1 Feder al Com m unications Com m iss i on,
c a l l e rs.T h e seru l e sa p p l to
y a l lmobile phones g
wwvrifcc. ov/911/enhanced. Accessed 6/24104.
l i c e n se ebs, ro a d b a n pde rso n com
a l m unication National Emergency Number Association,
s e r v i c easn dce rta isp n e ci amo l b iler adio wwW.nena.org. Accessed6124104.
l i c e n se e s.

H e f o r eS i v i n gC a r e | 7
 REACHING ANDMOVING
AN ILt ORINJURED
PERSON
"DoNoFurther
Harm"
O n eo ft h emo std a n g e ro th u sre a ts
to a ser iously
i n j u r epde rsoins u n n e ce ssamo ry vement. Usu-
a l l yw h e ng i vi n g ca reyo , uw i l ln o tfacedanger s
thatrequire youto movea person. In most
yo u
c a s e s , ca nfo l l o wth ee me rg ency steps
(CHECK-CALI-CARE)where youfindtheper-
s o nC , al l i nfog rh e l pi sth emo sti mpor tant step PACK-STRAP CABRY
y o uc a nta kei n a ne me rg e nto cyh elptheper son Tomoveeither a conscious or uncons c i ous
i n n e e do f ca re . pers0n-
Moving . Position yourself withyourbackto the
a seriously injured person cancause
additional injury andpainandcomplicate theper- per son.
son'srecovery. Therefore, youshould . Cross theperson's armsinfrontofyouand
movea per-
sononlyunder thefollowing threesituations: grasp the person's wrists.
1 . W h e nyo ua refa ce dw i thi mmediate danger . Leanfor war slightly
d andpulltheper s on
2, Whenyouhaveto getto another person who onto your back ( Fig.1- 6) .
mayhavea moreserious injuryor illness
3 . W h e nyo un e e dto p ro vi dpero per car e
Onceyoudecide thatyoumustmovea per-
sonbased ontheguidance above, youmust
quickly decidehowtomove theperson. Carefully
consider yoursafety andthesafety oftheperson.
Ba s ey o u rd e ci si oonnth ed a n g e you rs ar efacing,
thesizeandcondition oftheperson, yourability
andcondition andwhether youhaveanyhelp.
T oavo i di n j u ri nyo g u rseol frth eper son, use
y o u rl e gs,n o tyo u rb a ck, w h e nyo ubend. Bend
atthekneesandhipsandavoidtwisting your TW O.PERSON SEATCARRY
b o d yW . al kfo rw a rd w h e np o ssi b ltaking
e, sm all Tocar r ya per son whocannot walkan dhasno
s t e p sa n dl o o ki nwg h e reyo ua reg oing. suspected head, neckor backinjur y -
Avoidtwisting or bending anyone witha . Putonear mundertheper son'th s i ghs
p o s s i bh l ee a dn, e cko r b a cki n j u ryDo . notm ove andtheotheracr oss theper son bac's k .
a person whoistoolargeto movecomfortably. . Interlock yourarmswiththoseof a second
r esponder under theper son'leg s sand
Emergency Moves acr oss theper son'backs ( Fig.1- 7A) .
. Lifttheperson in the "seat" formedbythe
W A L KIN G A S S IS T
T oh e l pa p e rsow n h on e e d a s ssi stancewalking r esponder s' ( Fig.
ar m s 1- 78) .
to safety- . Move the person to
. P l a ce th ep e rso na'srma cro ss y ourshoul- safety.
d e r sa n dh o l di t i n p l a cew i tho nehand
( F i s1. -5 A ).
. S u pp o rtthpee rsow n i thyo u ro therhand
around theperson's waist.
. Movetheperson to safety.
. A second responder, if present, cansupport
t h epe rsoinnth esa mew a yo ntheother
s i d e( F i g1. - 5 8 ) .

fi I frrtt &!rJl[iFft.ie
l ]ff* r t i : * \ # * r k p l * * * F * r t i c i p x n t '\xA " f * r k h * * k
C T O T H EDSR A G FOOT DRAG
T om o v ea p e rsown h oma yh a vea head, neckor Tomovea person toolargeto carryor moveoth-
backinjury- erwise-
. G a th ethr ecl o th i nbge h i nth
d eper son'neck
s . Firmlygrasptheperson's anklesandmove
( F i g1. -8 ). backwar d.
. Pulltheperson to safety. . Pullthepersonin a straight
lineandbecare-
. W h il emo vi nthg ep e rso ncra , d le
thehead fulnottobum pthe per son' s (F i g.
head 1- 10) .
withtheperson's clothes andyourhands.

B L AN K EDTR A G
Tomovea person in anemergency situation
w h e ne q u i p meins lti mi te d -
. Kegptheperson between youandthe Gonfined
Spaces
blanket. A confined spaceis a space thatis lar geenough
. G a th ehra l th
f eb l a n keatn dp l aceit against andconfigured sothatanemployee canenter
the person's side. and perform assignedwork.lt haslimited or
. R o ll th pe e rsoansa u n i tto w aryou. d means
restricted of entryor exit(e.9.,
tanks, ves-
. R e ach o ve ra n d p l a ceth eb l a nket
sothatit sels,silos,storagebins,hoppers, vaultsandpits
w i l lbep o si ti o n uen d d eth
r ep e rson. ar espaces thatm ayhavelimited m ea nsof
. R o ll th pe e rsoonn toth eb l a n ket. Theyarenotdesigned
entry). for continuous
. G a th ethr eb l a n keattth eh e a dandmovethe employee occupancy.
p e rso(F n i g1. -9 ).

* e f r : r ef i i v i n gC a r e | $
SKILT
SHEET
WASHING
HANDS
W a s hyo u rh a n dw
s i thso a pa n drunning aftergiving
waterim m ediately car eevenif youwor e
disposable gloves. lt is important thatyouwashyourhandscorrectly-
1. Turnonwarmwater. 5.Rinseyourhandswithwater.
6.Dryyourhandsthoroughlywitha paper
towel.
7.Turnoffthefaucetusingthepapertowel.

Wethandswithwater.
Ap p l yl i q u i d
so a pto h a n d s.
lf hand- washing
facilities
ar enotr eadi l y
available,usealcohol- basedhandsani ti z er
ors
lotionsto cleanyourhands, butnotin pl ac eof
handwashing withsoapandwater.

R u byo u rh a n dtos g e th evir g or ously

forat
l e a st1 5se co n dco s, ve ri nagl lsur faces
of
t h eh a n d a
s n dfi n g e rs.

. Useso a pa n dw a rmru n n i ng water .

. Scru bn a i l sb yru b b i nth
g e magainst
the
pa l ms
of yo u r
h a n d s.

i * i i l i t s tA i d l i l P n / A Sf * r t h * W * r k p i n * *P * r t i * i g : * n 1W' ** r k b * * f <
 SKILL
SHEET:
WASHING
HANDS
W a s hyo u rh a n dw
s i thso a pa n drunning
waterim m ediately
aftergiving
car eevenif youw or e
disposable gloves. lt is important thatyouwashyourhandscorrectry-
1. Turnonwarmwater. 5.Rinseyourhandswithwater.
6.Dryyourhandsthoroughlywitha paper
towel.
7.Turnoffthefaucetusingthepapertowel.

2. Wethandswithwater.
3. Ap p l yl i q u i dso a pto h a n d s.
lf hand- washing
facilities
ar enotr eadi l y
available,usealcohol- basedhandsa ni ti z er
ors
lotionsto cleanyourhands, butnotin pl ac eof
handwashing withsoapandwater.

R u byo u rh a n dto
s g e th evir g o rouslyforat
l e ast1 5se co n dco s, ve ri nagl ls ur faces
of
t h eha n d a
s n dfi n g e rs.

. Useso a pa n dw a rmru n n i nwaterg .

. S cru bn a i l sb yru b b i nth
g e magainst
the
p al mso fyo u rh a n d s.

J* j Firs&
t i r i l t P n l & 4 fi l* r t h s W * r 1 < p i n $c ?
* * r r i * i p * nW
t ' so r k h o * k
SKITL REMOVING
SHEET DISPOSABLE
GLOVES
STEP remove
t: Partially thefirstglove. STEP3:Finish
removingbothgloves.
. Pinchthegloveatthewrist,beingcareful
to . Graspbothgloveswithyourfreehand.
touchonlytheglove'soutsidesurface, . Touchonlythecleaninter ior e the
sur facof
glove.

Pulltheglovetowardthefingertips
without
completely it.Thegloveis now
removing
STEP4:Afterremovingbothgloves-
partlyinsideout. . Discargloves
d in anappr opr i ate
c ontai ner .
. W ashyourhands thor oughly ,

STEP2:Remove thesecond glove.

. Withyourpartially gloved hand,pinchthe
outside surface ofthesecond glove.
. P u lth
l ese co n g d l o veto w a rdthefinger tips
u n tiilt i s i n si d e
o u t,a n dth e nremoveit
completely.

* e f c r eS i v i x gi l * r e i i 1
 CHECKING
ANILt ORINJURED
PERSON
CHECKING
A CONSCIOUS . Watchtheperson forsignalsof painand
PERSON listenforsoundsof pain.
. W atchforchanges in conscio us nes
ands
Forthepurpose offirstaid,anadultis defined as br eathing.
s o m eo naeb o u1t 2ye a rso f a g eo r olderSom . e- . Whenthecheckis complete, havetheper-
onebetween theagesof 1 and12yearsold sonrestcomfortably whileyoucareforthe
( s c h ooalg e di)s co n si d e re
ad ch ild. W henusing conditionsyoufind.
pediatric AEDequipment, a childis someone
between theagesof 1 and8 or weighing less Ghecking a Ghildor Infantfrom
than55pounds. An infantis someone lessthan
1 yearof age. Toeto Head
. W henchecking a childfornon l i fe-
First, checkthescene. Then,checktheper-
sonfor life-threatening conditions. Telltheper- threateningconditions, observe thechild
sonnotto moveandgetconsent to givecare.lf beforetouching him or her.
. Lookforsignals thatindicatech anges in
thereareanylife-threatening conditions, call
9-1-1 o rth el o cael me rg e nncy u m ber . consciousness, anytr oublebr e athi ng
and
lf therearenolife-threatening conditions anyappar ent injur ies
or conditi ons .
. Get at eyelevelwith the child( Fi g.
2- t) .
a n dt hep e rsoins co n sci o uas, sktheper son-
. Wh a ti syo u rn a me ? . Talkslowlyandin a friendly manner.
. Wh a th a p p e n e d ? . Usesimple words.
. Wheredoyoufeelanypainor discomfort? . Askquestions thatthechildcanans w er
. D oyo ufe e ln u mb n e o ssr l o ssofsensation? . easily.
lf so,where? W henyoubegin yourcheck, begi natthe
. Doyouhaveanyallergies? lf so,what? toesinstead of thehead. Checking inthis
. D oyo uh a vea n yme d i caco l nditions ordergivesthechilda chance to get usedto
or ar e
youtakinganymedications? lf so,whatcon- theprocess and allows himor her to see
ditions doyouhaveor whatmedications are whatis goingon.
y o uta ki n g ?
. Whendidyoulasteator drinkanything?
Givethis informationto emergencymedical
seruices(EMS)personnelwhentheyarrive.

Ghecking
anAdultfromHeadto Toe
. Telltheperson nottomoveanybodypart
thathurts.
. Be g i thn ech e cka tth eto po fthehead, face, Giving
Gare
ears,noseandmouth. 0nceyoucomplete theexamination,givecare
. Lookfor cuts,bruises, bumps, depressions, for anyspecific youfind.Togivecarefor
injuries
b l e e d i nogrfl u i d . theperson untilEMSpersonnel arrive,
follow
. Feeltheperson's forehead withtheback thesegener al guidelines:
ofyour(bare) handfortemperature (and . Donofurtherharm.
moisture). . l[onitorthe "ABGs"-Airway, Breathing
. Lookatthecoloring oftheperson'sface
and xi
Circulation. t
t
a n dl i p s. . Helptheperson restinthemostcomfortable
. Noticehowtheskinlooksandfeels.Noteif position. I
it is red,paleor ashen. . Keeptheperson fromgettingchilled
or
. Lookoverthebody, starting
atthehead, over-heated.
s ca n n i ndgo w nth eto rsoa, rm sandhands . Reassure theperson.
thenlegsandfeet. . Giveanyspecific car eneeded .
t i d l c P R l A fr *nr t h e\ { l n r k p l a cpea r r i c i p * * tw' sn r k b u c k
1 ? | F i r sA
 n'gGareActivity-Adult
Prioritizi
In anemergency youmayneedto determine
withmorethanonevictim, whoneedshelpfirst.Thisis
calledprioritizing
care.
Readthefollowing
Directions: emergencysituations.
Circlethevictimin eachemergency
situation
whohasa life-threatening andneedshelpfirst.
condition

Victim1 Thedriverof the truckwho getsoutto examine the driverand passenger af

the car.
r f th e c arwho is moaning
V i cti m2 T h ed ri ve o in painandappeartos havea cut on hi q
face,
V i cti rn3 T h e p a sse n g sro f the car who is not m ovingat all and appea r sto be
unconscious.

VictimI Thepersnn
whogetsupslowlyandsturnbles
awayfromthedebris,
Victim2 Theperson
whois bleedingseverely
andappearsto havea broken
arm,
Victim3 Theperson andtellsyouthatherankle
whois lyingonthcground hurtsand
shemayhavetwistedit.

t Theperson
Victim 0nthsgraund,
whofelloverandis nowsitting Hisskinappears
moist andheissweating
andashen, profgsely.
Victim?Theperson whohashot,red,dryskin.Heappearstobeunconsciousanddoes
notrespond whenynuaskhowheisfeeli,ng"
3 Theperson
Viotim whoissweatingheavilyandwhnse paleandmoist.
skinappears
l-leis complaining
thatheistired.

C h e c k i n*gn l l l a r I nj u r e dP e r s t n | 1 3
 Prioritizing
GareActivity-Child
In anemergency withmorethanonevictim,
youmayneedto determine
whoneedshelpfirst.Thisis
calledprioritizing
care.
Directions:
Readthefollowing
emergencysituations.
Circlethevictimin eachemergency
situation
whohasa life-threatening
condition
andneedshelpfirst.

VictimI Theadultdriver whois calling

forhelpbutwhoutherwise
appears
uninjured"
Victinn2 Thechildwhoisseated ina carseatinthebackmiddle
passenger
seatand
whois notmoving andappears to beunconscious.
Vietirn3 Theolderchildwhaisseated behind themother ynuseea small
andcrying"
cutonhisrigl"rt
lowerleg.

Victim1 Thechildwhohasa gashonhisforehead,whichis bleeding.

Victim? Thechildwho.is
cryingandtrying
t0 removeherarm,whichistrapped
betweenboards,butwhodoesnotappear t0 bebleeding.
Victim3 Thechildwhowashitbyfellingboardswhois lyingquietly,
appears
unc0n-
scious
andis bleeding
froma gashonhisarm.

Victim1 Thecrying
toddler
whofellfromherhighchair"
Victim2 Theschool-aged
childwholookspanicked
andis clutching
histhroat.
Victim3 Themotherwhois bleeding
fromherhand.

1 4 | F i r sA
t i d / c p R / A ft o
Drt h ew o r k p l a cPea r t i c i p a nwt 'osr k b o o k
RECOGNIZING
ANDCARING AN UNCONSCIOUS
CHECKING
FORSHOCK PERSON
Shockis a life-threatening condition inwhichnot lf youfindthattheper son is unconsc i ous and
enough bloodis beingdelivered to allpartsofthe 9- 1- lorthelocalemer gency number hasbeen
bodyandbodysystems, andorgans begin t0 fail. called, findoutif thereareotherconditions that
A p e r s osh
n o w i nsi g g n a losfsh o ckn eeds imm e- threaten theperson's life.Alwayscheckto seeif
diatemedical attention. Shockis likely to develop anunconscious per son-
afteranyserious injuryor illness including severe . Hasanopenairway.
bleeding, serious internal injury, significant fluid . Showssignsof life(movement or breathing).
lossor otherconditions. The goals offirstaidare . ls bleedingsever ely.
to gethelpquickly andgivecareto minimize An easywayto remember thisisto think
s h o cw
k h i l eca ri nfo o r i l lness.
g rth ei n j u ry "ABC,"whichstands for:
. Airway-0pentheairway.
Si g n a l so f S h o ck . Breathing-Check formovement or breathing.
T h es i g na lth a p e rsomay
s a ti n d i ca te n begoing . Cir culation- Check forsignsof life( i nc l ud-
i n t os h o cki n cl u d e - inga pulsefora childor infant) an ds ev er e
. Restlessness or irritability, bleeding.
. Altered levelof consciousness. Because childr enandinfants ar es m al l er
. N a u seoarvo mi ti n g . thanadults, youdonothaveto tilttheirheads
. R a p ib d re a th i nagn dp u l se . backquiteasfarto opentheirairway. Tilting
. Pa l eor a sh e nco , o lmo
, i stski n . theheadbacktoofarcanalsoblockth eai r w ay
. Excessive thirst. ( Fis.2- 3A- C) .

Garefor Shock
. M a kesu reth a t9 -1 -1 o rth el o calemer gency
n u m b ehra sb e e nc a l l e d .
. Continue to monitor theperson's ABCs.
. Control anyexternal bleeding.
. Keeptheperson fromgetting chilledor
overheated.
. El e va th te el e g sa b o u1t 2i n ch eifs a head,
o r i f b ro kebones
n e c ko r b a cki n j u ry n inthe
h i p sor l e g s n o t
a re su sp e cte d (Fig.2- 2) .
. Comfort andreassure theperson untilEMS
personnel arriveandtakeover. adults,
Unlike children seldom initially
suffer
Donotgivethepersonanything to eatol a cardiac
emergency. Instead,theysuffera
drink,eventhoughheor sheis likelyto be breathing
emergency thatresults in a cardiac
thirsty. Theperson's condition maybesevere emergency. checkfora pulse
Fora childor infant,
e n o u gtho re q u i resu rg e ry, i nw h i chcaseit is fornomorethan10seconds. Fora child,you
betterif thestomach is empty. wouldneedto feelfora carotidpulse (Fig.
2-4A)
andforaninfant,
thebrachial pulse(Fig. 2-aB).

1 $ i F i r s i& i q : t l i l F Rill&f *f r t h * W * r k p l a c *F * r l i * i p n n t W
's *rkh*nk
 ROLTING
A PERSON
FACE.UP bodyattheshoulder andatthehip.Tak e thear m
lf anunconscious personis face-down, farthest awayfromyouandmoveit upnextto
you
needto rolltheperson thehead. Taketheotherarmandcrossit over
ontohisor herback.
Position yourself soyouarefacingthebackof thechest. Then,bendthelegclosest to you.
theperson's head,Movethearmthatis closest Suppor ting theshoulder andhip,gentl ryol l the
to youupnextto thehead.Placeyourhandsat person awayfromyouwithout twisting thebody.
t h eb a cko fth en e cka n dyo u ro th erhandonthe Becar eful to supporthet headsotha ti t angl es
h i pG . en tlro y l l th ep e rsoto
n w a rd
you,keeping towar d thegr ound. Thiswillallowflui ds to dr ai n
t h eh e a dn, e cka n db a cki n a stra ight awayfromthethroat.
line
( F i g2. - 5 ).
0 n ceth ep e rsoinso nh i sor herback, lf theperson hasbeenintherecovery posi-
youneedto opentheairway. tionfor30minutes or moreandbegins to show
signsof lossof circulation to thelowerarm(such
aspale, ashen or gr ayish
skinthatis cool tothe
touch), turnhimor herto theopposite side.
lf yoususpect a head, neckor ba c ki nj ur y
anda clearopen, air waycanbem aintai ned,
donotmove theper son unnecess arl fi layc. l ear
air way cannot bem aintained or if yo um us t
leave theper sonto gethelpor getanAED ,
movetheper son to hisor hersidewh i l ek eepi ng
thehead, neckor backin a str aight linebypl ac -
SEVERE
BTEEDING inghimor herin a modified H.A.tN. E.S. ( H i gh
C h e cfkorse ve re b l e e d i nbgyq u i ckly
looking Armin Endangered Spine) recovery position
overtheperson's bodyfromheadto toeforsig- ( Fig.2- 64- B) .
n a l ss u cha sb l o o d -so a ke cl odth i ng
or blood
s p u r t i nogu to f a w o u n dB, l e e d i ng
usually looks
w 0 r s et h a ni t i s.A sma lal mo u notf bloodona
slicksurface or mixed withwateralmost always
lookslikea greatdealof blood. lt is notalways
e a s yt o re co g n i zese ve re b l e e d i ng.

RECOVERY
POSITION
lf youarealoneandhaveto leave theperson for
anyreason, suchasto callforhelpor getanAED,
placetheperson in a recovery position.Placing
a
person in a r.ecoveryposition willhelptheairway
remain openandclearif heor shevomits.
To place a person in a recoveryposition,
kneelattheperson's sidesoyoucansupport the

C h * c k i na
g n l l l n r I n j u r * dP e r s o nt 1 7
 AN ILL ORINJURED
SKILLSHEETCHECKING PERSON
F o rA d u l(A
t g e1 2o r 0 l d e r) give2 rescuebreaths.
5. lf notbreathing,

gasping
fip: lrregular, or shallow
I'J,,y.ili;:Hi:':,'i?ffiili' breaths arenoteffective.

1 . CHECK scene,
thenGHECKtheperson.
2. Tapshoulder "Are
andshout, youokay?"
3. lf noresponse,
CALL9-1-1.

Tip:lf an unconscious person

is
..
face-down-Roll face-upsupporting
the
h e a d,
n e cka n db a ck.

4. 0pentheairway(tilthead,liftchin).
CHECK for movement andbreathing
for no
m o r eth a n1 0se co n d s.
Tip:Alsoquickly
scanforsevere
bleeding.

Tip:lf checking
anunconscious
childor
infantandbreaths goin,GHEGK
for a
pulsefor nomorethanl0 seconds
{see
Fig.2-4A-Bon p. 16).

lf theperson placehimor her

isbreathing,
position
in a recovery andmonitorABCs.

1 $ | F i r s rA i e l l I P R I A I nf * r t h e W a r k p l * c eF a r t i c i p a n tW
's r:r"kbook
BREATHING
EMERGENGIES
ANDCONSCIOUS
CHOKING-
ADULT,
CHILD
ORINFANT
BREATHING
EMERGENCIES
A breathing emergency occurswhena person is
having troublebreathing (respiratory distress) or
cannot breathe at all(respiratory arrest).
Breath-
i n ge m e rg e n ciaere ( Fig.
s l i feth re a te ning 3- l) .

0 minutes:Breothing stops. Heort will soon stop beoting.

4 6 minuies:
Broin domoge possible.
. In anunconscious youmaydetect
adult,
6 - 1 0 m i n u t e sB:r o i n gasping
ir r egular , or shallow
br eaths T .hes e
areknownasagonal breaths.
D0 NOTcon-
fusethiswithnormal
fil;:,;:::,,rreversbe . Theperson's
breathing.
skinis unusually
moistor cool
andhasa flushed, pale,ashenor bl ui s h
appear ance.
. Theperson feels-
o Shortof breath.
o Dizzy or light-headed.
o Paininthechestor tingling inthehands ,
feetor lips.
Gauses
of Breathing
Emergencies o Apprehensive orfearful.
. A partially obstructed airway
. l l l n ess Signals
of Breathing
Emergencies-
. C h r o n co
i c n d i ti o nsu
s,cha sa sthm a ChildandInfant
. Electrocution . Agitation
. Heartattack . Unusually fastor slowbr eathin g
. I n j uryto th eh e a dch , e st,
l u n g sor abdom en . Drowsiness
. Al l e rg ire
c a cti o n . Noisybreathing
. D r ug s . Pale, ashen, flushed or bluish
ski nc ol or
. Po iso n i n g . Br eathing tr oubleincr eases
. Emotional distress . Change inthelevelof conscious nes s
. lncreased heartrate
Signals
of Breathing
Emergencies- . Sudden silence
Adult It isveryimportant to recognize
breathing
. Theperson hastroublebreathing (Fig.3-2). emergencies in childrenandinfantsandto act
" B re a th i n
i g
s sl o wo r ra p i d . before theheartstopsbeating. Adults'heartsfre-
o Bre a thasreu n u su a ldl ye e po r shallow. quentlystop beating because theyarediseased.
. Theperson is gasping for breath. Infants'and children's hearts,howevet, areusu-
. T h epe rsoinsw h e e zi nggu, rg l ing or making allyhealthy. Whenaninfantor child's heartstops,
high-pitched noises. it is usuallythe resultof a breathing
emergency.

sreathing
I r n * r g c n c i easn dt s n s c i a u si l h n k i n g - A d r * tCt ,h i l do r I n f a n tI 1 g
SomeGonditions
thatGause
Breathing ALLERGIC REACTION Allergic reactions alsocan
Emergencies causebreathing problems. At first,thereaction
ASTHMA Asthma is a condition thatnarrows mayappear to bejusta r ashanda feel i ng of
t h ea i rp assa g eAs.n a sth ma a tta ckhappens tightness inthechestandthroat,butthis
w h e na t r i g g e sur, cha se xe rci se , air ,aller - condition
cold canbecome lifethr eateninTg. he
gensor otherirritants, per son'face,s neckandtongue m aysw el l ,
causes theairwayto
swellandnarrow. Thismakesbreathing difficult, closing theairway. A severe allergic reaction
whichisfrightening. Youcanoftentellwhena can cause a condition called anaphy l ac ti c
p e r s oins h a vi nagna sth ma a tta ckbythehoar se shock, also known as anaphylaxis. Dur i ng
w h i s t l i nso
g u n dh eo r sh ema kew s hileexhaling. anaphylaxis, airpassages mayswellandr es tr i c t
T h i ss o un dkn a per son' s
br eathing. Signals of anaphy l ax i s
, o w na sw h e e zi nogccur , s
b e c a u se ai rb e co metra s p p eidnth elungs. include r ashes; tightness inthechesta ndthr oat;
C o u g h i nagfte re xe rci se cryi
, ng o r l aughing ar e and swelling of the face, neck andton gue. T he
per son mayalsofeeldizzy or confuseSom d. e
o t h e sr i g n a lth
s a ta na sth ma a tta cki staking
p l a c eU. su a l lpy,e o p ldei a g n o sewdi thasthma people know that they ar e aller gic
to cer tai n
c o n t r o l th eai tta
r cks w i thme d i ca tions. These substances. Theymayhavelear ned to av oi d
m e d i c ati osto n s pth emu sclsp e a sm andopen these things and may car r m
y edicati to
on
t h ea i r w a y,w h i chma ke bs re a th i neasier g For
. r ever se thealler gic r eaction. Formor e
m o r ei n f orma tio na sth ma se eA p pendix G. infor m ation
on aller r
giceactions andtr eatm ent
foranaphylaxis seeAppendix H.
EMPHYSEMA Emphysema is a disease that
i n v o l v edsa ma gto e th el u n g s' a i rsa cs.lt is a
c h r o n i(clo n g -l a stionrfre g q u e n tlreoccur
y r ing) CONSCIOUS CHOKING
disease thatworsens overtime.Themostcom- A d u l to r G h i l d
monsignalof emphysema is shortness of breath. . Choking is a br eathing emer gen c y .
Exhaling is extremely difficult. ln advanced . lt is a comm on injurthat
y canleadto death.
cases, theaffected person mayfeelrestless, . lf a per son is conscious andcann ot c ough,
confused andweak,andmayevengointorespi-
speakor breathe, assume thattheairwayis
ratoryor cardiac arrest.
blocked.
BR0NCHITIS Bronchitis is a condition that . A per son whois choking mayclut c hat hi s
c a u s etsh eb ro n ch itu a lb e sto b e come swollen (Fig.
or herthroat 3-3).Thisgesture isthe
a n di r r i t ateTdh. i si n fl a mma tica o nu s es a build- univer sal signof choking.
u po f m ucuth s a tb l o cks th ep a ssa ge of airand . Comm on causes of choking include-
a i re x c ha n gi neth el u n g s. A p e rsowith n br on- o Trying to swallow largepieces of poorly
chitiswilltypically havea persistent coughand chewed food.
mayfeeltightness inthechestandhavetrouble o Eating whiletalking excitedly or l aughi ng,
breathing. Aswithemphysema, theperson may or eating toofast.
alsofeelrestless, confused andweak,andmay o W alking, playing or r unning withfoodor
go
even intorespiratory or cardiac arrest. in
objects the mouth.
Additional causes of adultchoking aredrink-
HYPERVENTILATI0N Hyperventilation occurs ingalcohol m eals ohol
( alc
beforor e dur ing dul l s
whena person breathes fasterandmoreshal-
l o w l yt h a nn o rmaWh l . e nth i sh a p p ens, thebody
doesnottakein enough oxygen to meetits
demands. People whoarehyperventilating feel
asif theycannot enough get air.Often theyare
afraidandanxious or seemconfused. Theymay
saythattheyfeeldizzy orthattheirfingers and
toesfeelnumbandtingly.

2S I FirsA
t i d l C F n l Anf f e r trh * W n r k p l * c nF a r t i * i p a n tW
' sn r k h * * k
thenerves thataidswallowing) andwearing den- object.An infantwitha complete airway
tures(dentures makeit difficultto sense whether obstructionis unable to cough,cryor breathe.
foodisfullychewed before it isswallowed). Tofreetheblockage intheinfant's
airway,
A p e rsow n i tha p a rti a lbl yl ockedair way can youcangivebackblowsandchestthrusts,
s t i l mo
l vea i rto a n dfro mth el u n gs, soheor she eitherstanding or sitting,
aslongastheinfantis
cancoughto tryto dislodge theobject. A person onyourthighandtheheadi s l ow er
suppor ted
w i t ha co mp l e tebl lyo ckeadi rw ay cannot cough, thanthechest.lf theinfantis largeor your
s p e ao k r b re a th T eh. i sp e rsonneeds backblows handsaretoosmallto adequately support the
a n da b d o mi n a l th rutosts cl e athe
r air way. Give you
infant, maypreferto sit.
chestthrusts instead of abdominal thrusts to a
c h o ki npge rsow n h oi s o b vi o u sly pr egnantor CHOKING
PREVENTION
FOR
knownto bepregnant ortoobigforyouto reach
a r o u n(F d i g3. -a A l .f yo ua rea l o neandchoking, CHITDREN
ANDINFANTS
l e a nove ra n dp re ss yo u ra b d o men against any Dangerous
Foods
firmobject(Fig.3-aB). Youcangiveyourself Donotfeedanyround, firmfoodto children
a b d omi nth a lru sts b yu si n gyo u rhands ( Fig.
3- younger
than4 yearsof ageunless thefoodis
4 C )Gi . vea ch o ki nvi g cti mi n a w heelchair choppedcompletely. Thefollowingfoodscanbe
a b d o mi nth a lru sts(F i g3. -a D ). choking
hazar ds:
. Hotdogs
. Nuts
. Chunks of m eator cheese
. Har dor stickycandy
. Popcor n
. Rawcarrots
. W holegr apes
. Chunks of peanut butter
Dangerous
Household
ltems
Keepthefollowing household itemsstored
safelyoutof reachof infantsandchildren:
. Balloons
. Coins
. Mar bles
. Smalltoy par ts
. Penor m ar ker caps
. Small,button-type batteries
Small,compressible toysthatcanfit entirely
intoa child's
mouth
Infant Plasticbags
Choking is a majorcauseof injury anddeathin ActionStepsto Prevent Ghoking
infants. Aninfantcaneasily swallow smallobjects Seatchildr enin a highchairor at a tabl e
orsmallpieces offood,whichcanthenblockthe whiletheyeat.
airway. Additional reasons forchoking include- a Donotletchildren
eattoofast.
. Theinfant's airwayhasnotfullydeveloped. a Give infants
softfoodthattheydonotneed
. T hei n fa nht a sn o tfu l l yd e veloped
hisor her to chew.
e ati n ski
g l l s. a
Super vise
childr en whiletheye at.
An infantwitha partial airwayobstruction a
Cutfoodintosmallbitesfor infants and
c a ns ti l mo
l vea i rto a n dfro mth elungs, soheor youngchildr en,andteachthemto c hew
s h ec a nco u g hi n a na tte mptot d islodgethe theirfoodwell.

fir*nihinE
{ l r : * i g * n * i * *i r r : *i l * n i ; * i * * si l h * k i n 6 * * & c i *illth. , i d* r ! * i * * t I } r
RESCUEBREATHING-
ORINFANT
CHILD
It is important to remember thefollowing about
r e s c ub e re a th i n g :
. I n ju ry o r i l l n e ss
ca nso me ti mes causea
c h i l do r i n fa n tto sto pb re a th ing.
. Rescue breathing istheprocess of breath-
i n ga i ri n toa p e rsow n h oi s n otbr eathing.
. T hevi taol rg a ndse p e nodna c onstant sup-
plyof oxygen to function properly.
. l t i s n a tu ra l to fe e lu n co mfo rtableabout theper son
r eposition
3. Car efully o nhi sor her
making mouth-to-mouth contact witha back.
stranger, eventhough theriskof disease 4. Replacethebr eathing
bar r ier .
transmission is verylow. 5. 0pentheairway.
. A r e su sci ta tima o n sko rfa ce -shield[also 6. Continuewithr escuebr eathinas g needed.
k n o w na sa ca rd i o p u l mo nresuscitation
ar y
( CP Rb)re a th i nbga rri e rlma , yr educe ther isk Breathing
Mouth-to-Nose
of disease transmission between the lf youar eunable
to m akea tighteno ugh s eal
r e s p o n daenr dth ep e rso n . overtheperson's mouth,youcanbreathe into
. R e scubere a th i nsh g o u lndo tbedelayed thenose.
yo u
b eca u se d on o th a vea b reathing bar r ier 1. Withtheheadtiltedback,closethemouth
or knowhowto useone. bypushingonthechin.
2. Sealyourmoutharound theperson's nose
andbreathe (Fig.
intothenose 4-2).
SITUATIONS
SPECIAL opentheperson's
3. lf possible, mouth
betweenrescuebreaths to lettheairout.
Ai r i n th e S to ma ch
W h e nyo ua reg i vi n re g scu b e re a ths, becar eful
to avoidforcingairintotheperson's stomach
i n s t e ad
o fth el u n g s. T h i sma yh a ppen if you
breathe toolong,breathe toohardor donot
o p e nt hea i rw afa y re n o u g A h .i ri nthestomach
cancausetheperson to vomitandsuffercom-
p l i c a ti o nas,
n di t a l soma keist h a rder forthe
d i a p h ra gth m,el a rg emu sclth e a tcontr ols Mouth-to-Stoma
Breathing
breathing, to move. Thismakes it harder forthe
A stoma is anopening inthefrontoftheneck
lungsto fillwithair.
through whicha person whoselarynx hasbeen
removed or partially
removed breathes (Fig.4-3A).
Vomiting
It carefor a person witha stoma-
lf theperson begins to vomit,remove thebreath-
1. Look, listenandfeelfor breathing withyour
ingbarrier, then- (Fig.
'1.Turntheperson's earoverthestoma a-38).
headandbodytogether as
2. Givebreaths intothestoma, breathing atthe
t th esi d e{F i ga. -1 ).
a u n i to
samerateasformouth-to-mouth breathing
2. Wipeouttheperson's mouthwithyour ( Fig.
I a- 3C) .
finger.

* f | i l i r * t, & i * / i l f f i l g fi l f * r t h * W * r k p i a r : *f n r t i * ! p x n t 'W
s *rkh*$k
 Drowning
Tocar efora per sonwhois uncons c i ous
andnot
br eathing-
1. Attempt rescuebreaths.
2. lf airdoesnotgoin,reposition
theairway
andgivebr eaths again.
donotgoin,givecar eforunc on-
3. lf br eaths
scious choking.
4. 0ncetheairwayis clear,giverescue
br eathingor CPRasneeded.

H e a dN, e c ko r B a c kI n j u r i e s
Tocarefor a person
whoyoususpect hasa
head,
neckor backinjur y-
. Tr ytom inimize
movement oftheh eadand
neckwhenopening theair way .
Whengivingmouth-to-stoma breathing, air . Tilttheheadandliftthechinto openthe
m a yl e a kth ro u gthh en o sea n dm outh, airway.
d i mi n i sh ith
n gea mo u notf re scue br eaths
t h a tre a chth el u n g s. youneed
l f th i so cc ur s,
t o se a l th e
n o sea n dmo u th w i thyourhand
t o p re ve nati rfro me sca p i ndgur ing r escue
b r e a th i n g .
4. Remove yourmouth fromthestoma
between breaths to lettheairflow
b a cko u t.

r e * t h i ng , l - A du i t , i l h i l e*j r I n f n n t I ? n i
i Q $ su* $ $ 3
 -f

CARDIAC
EMERGENCIES
PREVENTING
HEART
DISEASE
Guidelinesfor a Heart-Healthy
Lifestyle
. Eata balanced dietthatlimitstheintakeof
saturated fatandcholesterol.
. Participatein continuous, vigorousphysical
activityfor20to 30minutes or moreat least
threetimesa week.
. Havebloodpressure andcholesterollevels
c h e ckere
d g u l a rl y.
. Maintain appropriate weight.
. Avoidtobacco use.Donotstartsmoking . Pale,ashen ( gr ayish)
or bluish
ski n
andif youdosmoke, quit. . Sweating
. Denialof signals
Heart-Healthy
1.0.
Thefollowing Bothmenandwomenexperience themost
statements represent a heart-
healthy com m on hearattack
t whichis chespai
signal, t n
lifestylethatcanreduce yourchances of
heartdisease. or discomfort.
Butwomenaresomewhat more
Check eachstatement that
reflectsyourlifestyle. likelythanmento experience someoftheother
warning signals,particularlyshortnessof breath,
n I d ono tsmo ke a n dI a vo i di n h aling
the nausea/vom iting andbackorjawpainW . om en
smoke of others. alsotendto delaytellingothersabouttheirsig-
tr | eata balanced dietthatlimitsmyintakeof nalsto avoidbothering or worrying
others.
saturated fatandcholesterol.
n I participate in continuous, vigorous physical
CAREFORA HEART
activityfor20to 30minutes or moreat least
ATTACK
threetimesa week. . C a l l 9 - 1o- 1
r t h el o c ael m e r g e nncuym b e r .
. Havetheperson stopwhatheor sheis
I I h a vemyb l o o dp re ssu re ch e cked r egular ly.
doingandrestcomfortably,
n I maintain anappropriate weight. . Loosen anytightor uncomfortable clothing.
lf youdidnotchecktwoor moreofthestate- . Closely watchtheper son untilemer genc y
m e n t sy,o ush o u lco
d n si d e r ki ncghanges
ma in m edical ( EMS) per sonnel
ser vices ar r i v e.
yourlifestyle now Notice anychanges intheper son's appear -
anceor behavior .
. Trytoobtaininformation aboutthe person's
RECOGNIZING
A HEART
ATTACK
condition.
Signals
of a HeartAttack . Comfort theperson.
. Persistent pain
chest (aprimary
orpressure . Assistwithmedication, if prescribed.
signalof a heartattack) thatlastslonger than . 0fferanaspirin if medically appropriate and
3 to 5 minutes or goesawayandcomes back loc6l protocols allow
. p a i nsp re a d i ntogth esh oulderneck,
C h e st s, . Bepr epar ed to givecar diopulmonar r esyus -
j a wo r a rms(F i g5. -1 ) citation (CPR) if the person's heartstops
. Shortness of breath or trouble breathing beating anduseanautomated external
. N a useoar vo mi ti n g defibr illator ( AED) if oneis availa bland e y ou
. D i z zi n e ss,
l i g h t-h e a d e d noerfainting
ss ar etr ained to doso.

2 4 | F i r s tA i d l C P R / A IfD
a r t h e W o r k p l a cP
e a r t i c i p a n tW
' sn r k b o n k
ASPIRIN
GANLESSEN
HEART
ATTACK
DAMAGE
Yo um a yb ea b l eto h e l pa co n sci ous per sonwho
is showing earlysignals of a heartattackby
offering himor heranappropriate doseof
a s p i r iwh
n e nth esi g n a lfisrstb e g i n. However ,
y o us h o u l n d e vedr e l a yca l l i n9g-1 - to
1 dothis.
Alwayscall9-1-1assoonasyourecognize the
signals, andthenhelptheperson to becomfort- 9- 1- 1
orthelocalem er gency num beim r m edi -
a b l eb e fo re yo ug i veth ea sp i ri n . ately.Although r ar e,childr enandteenagercsan
T h e ni ,f th ep e rsoins a b l eto ta kem edicine exper ience car diac ar r est.
bymouth, askif heor she- Thegreatest chance of survival fromcardiac
. l s a l l e rg ito
c a sp i ri n . arrestoccurs whenthefollowing sequence of
. H a sa sto ma ch u l ce or r sto mach disease. events happens asrapidly (Fig.
aspossible 5-2):
. l st a ki n g a n yb l o o d
th i n n e rs, suchasW ar - L Earlyrecognition andearlyaccess. The
farinrM or CoumadinrM. sooner 9- 1- 1orthelocalemer g enc num
y ber
. Hasbeentoldbya doctorto nottake is called, thesooner ear lyadvanc ed m edi c al
a s pi ri n . carearrives.
lf theperson answers noto allofthese 2. EarlyGPR. EarlyCPRhelpscirculate blood
questions, youmayofferhimor hertwo chew- thatcontains oxygen to thevitalorgans until
a b l e( 1 62 mg )b a b ya sp i ri nos,r u pto one5- gr ain anAEDis r eady to useor advanc ed m edi c al
(325 m g)a d u lat sp i rita n b l ewt i tha smallamount per sonnel ar r ive.
ofwater.Besurethatyouonlygiveaspirin and 3. Earlydefibrillation. Mostpersons withsud-
n o ta c eta mi n o p h e n(T yl e n o l ) (
o r i b u pr ofenMotr in dencar diac needanelectr ischoc k
ar r est
or Advil), whicharepainkillers. Likewise, donot called defibr illation.Eachm inute t hatdefi b-
usecoated aspirin products or products meant r illationis delayed r educes thechanc of e
f o rm u l ti p luese ssu cha sco l dfe , verand survival byabout10percent.
headache. 4. Earlyadvanced medical care.Thisis given
Youmayalsoofferthesedosesof aspirin if bytr ained medical per sonnelwho gi v efur -
y o uh a veca re dfo rth ep e rsoann dheor shehas thercar eandtr anspor tto hospi tal fac i l i ti es .
r e g a i n ecod n sci o u sn e a ss
n di s a b leto takethe IntheCar diac Chain of Sur vival e ac
, hl i nkof
a s p i r iby
n mo u th . thechaindepends onandis connec ted to the
otherlinks.lt isveryimportant to recognize and
startCPR promptly andcontinue it untilanAED
CARDIAC CHAIN OFSURVIVAL is available or EMSper sonnel ar r ivea ndtak e
C a r d i ac
a rre sti sth eco n d i ti oi nnw hichthehear t overAny . delayin calling 9- 1- 1
orthel oc alem er -
stopsfunctioning altogether. CPRaloneis not gencynumber star
, ting CPRandusin ganAED
e n o u gtoh h e l pso me o nsu e rvi ve car diacar r est. makes it lesslikelytheperson willsurvive.
E m e r ge nme cy d i cacal rei s n e e d ed assoonas Remember, you,thelayresponder, arethefirst
possible. Thisiswhyit is soimportant to call linkintheCar diac Chain of Sur viva l .

t u : r i i t c [ i n l r : ' q c n e l e Is ? 1
GPR
ANDUNCONSCIOUS
GHOKING-
ADULT,
CHILD
ORINFANT
CPR-ADUtT Continue
CPRuntil-
. Another trainedpersontakesoverCPR
A na d u litn ca rd i aacrre st
i s u n consciousand
showsnoothersignsof life(movement foryou.
or . Em er gency medical ( E M S)
ser vices per s on-
breathing). Lossofthesesignsof lifecanindi-
catecardiac nelarriveandtakeovercareoftheperson.
arrest. A combination of chest . An automated external (AED)
defibrillator
c o m pre ssi oannsdre scu b e re a ths
canhelpcir -
becomes r eadily
available.
culatebloodcontaining oxygen to vitalorgans . Youareexhausted
(cardiopulmonary resuscitation andunable to continue.
or CPR). . Thescenebecomes unsafe.
. Signsof lifereturn.
CPR-CHItD
U n l i kad
e u l ts, ch i l d resen ldom i n i tially
suffera TWORESPONDERS
AVAITABLE
cardiac emergency. Instead, theysuffera lf tworesponders trainedin CPRareatthescene,
breathing emergency thatresults in a cardiac youshould bothidentify yourselves asbeing
emergency. Motorvehicle crashes, drowning, tr ained
inCPR. 0neshould call9- l- 1o rthel oc al
smoke inhalation, poisoning, airwayobstruction, emergency number forhelp,if thishasnotbeen
firearm i n j u ri easn dfa l l sa l la recom m on causes done, whiletheotherprovides CPR. lf thefirst
of breathing emergencies thatcandevelop into responder istiredandneeds help-
a c a r d i aecme rg e n cy. A ca rd i aecm er gency can . Thefir str esponder should tellthes ec ond
alsoresultfromanacuterespiratory condition, responder to takeover.
suchasa severe asthma attack. . Thesecond r esponder should imm edi atel y
beginCPRstarting withchestcompressions.
CPR-INFANT
A cardiac emergency in anotherwise healthy UNGONSCIOUS
CHOKING
infantis uncommon unless it is preceded by lf youattempt rescuebreaths butareunable to
trauma or a breathing
emergency, likedrowning maketheperson's chestclearly rise,youmust
or choking,andtheinfant hasnotbeensuccess- actquickly to getairintotheperson. Thecare
fullyresuscitated
intime.Infants bornwithgenetic foranunconscious choking per son
isv er ys i m i -
or congenitalproblemsalsomaybeat increased larto theskillof CPR,withtheexception that
riskforcardiacemergencies because of problems youlookfor{ andr emove) a for eign
obj ec t
withtheheart'sstructure orfunction. between compressions andbreaths. Chest
compressions areusedto helpforceairfromthe
CPRFOR person's lungsto dislodgetheobject.
CHITDREN
ANDINFANTS
te ch n i q uyo
T h eC P R e uu seo nch i ldr en
andin-
fantswillbeslightly differentbecause infants
and
children havesmaller bodies andfasterbreathing
andheartrates. Youwillneedto adjust yourhand
positionandcompression (Fig
depth 6-1A-D).

? S I F i r s tA i d i I F R l ASf f o r t h e W n r k p lcee P a r t i * i n a n tW
' s* r k b s c k
ASPIRIN
GANLESSEN
HEART
ATTACK
DAMAGE
Y o um a yb ea b l eto h e l pa co n scious per sonwho
is showing earlysignals of a heartattackby
o f f e r inhgi mo r h e ra na p p ro p ri ate doseof
aspirin whenthesignals firstbegin. However,
y o us ho u lnde vedr e l a yca l l i n9g-1- to 1 dothis,
Alwayscall9-1-1assoonasyourecognize the
signals, andthenhelptheperson to becomfort- 1 thelocalemer gency
9- 1- or number i m m edi -
ablebefore yougivetheaspirin. ately. Although r ar e,childr en andte enagercsan
T h e ni ,f th ep e rsoins a b l eto takemedicine exper ience car diac ar r est.
bymouth, askif heor she- Thegreatest chance of survival fromcardiac
. l s a l l e rg ito
c a sp i ri n . arrestoccurswhenthefollowing sequence of
. H a sa sto ma ch u l ce o
r r sto mach disease. events happens asrapidly aspossible (Fig.5-2):
. l sta ki n g a n yb l o o d
th i n n e rs,
suchasW ar - l. Earlyrecognition andearlyaccess. The
farinrM or CoumadinrM. sooner 9- 1- 1 orthelocalem ergenc num
y ber
. Hasbeentoldbya doctorto nottake is called, thesooner ear lyadvanc ed m edi c al
a sp i ri n . carearrives.
lf theperson answers noto allofthese 2. Ear lyGPR, Ear ly CPRhelpscir c ul ate bl ood
questions, youmayofferhimor hertwo chew- thatcontains oxygen to thevitalorgans until
a b l e( 16 2mg )b a b ya sp i ri nos,r u pto one5- gr ain anAEDis r eady to useor adva nc ed m edi c al
{325 mg )a d u lat sp i rita n b l ewt i tha sm allam ount personnel arrive.
ofwater.Besurethatyouonlygiveaspirin and 3. Earlydefibrillation. Mostpersons withsud-
notacetaminophen (Tylenol) or ibuprofen (Motrin dencar diac ar r estneedanele c tr ischoc k
or Advil), whicharepainkillers. Likewise,donot called defibr illation.Eachminute thatdefi b-
usecoated aspirin products or products meant r illationis delayed r educes thechanc of e
f o rm ul ti p luese ssu cha sco l dfe , verand sur vival byabout10per cent.
headache. 4. Earlyadvanced medical care.Thisis given
Youmayalsoofferthesedosesof aspirin if bytr ained m edical per sonnel wh ogi v efur -
y o uh aveca re dfo rth ep e rsoann dheor shehas thercareandtransport to hospital facilities.
r e g a i n ecod n sci o u sn a enssdi s a bleto takethe IntheCar diac Chain of Sur viv aleac, hl i nkof
a s p i ribnymo u th . thechaindepends onandis conne c ted to the
otherlinks.lt isveryimportant to recognize and
startCPR promptly andcontinue it untilanAED
CARDIAG CHAIN OFSURVIVAL is available or EM Sper sonnel ar r iv e
andtak e
C a r d i aacrre sti sth eco n d i ti oi nnwhichthehear t overAny . delayin calling 9- 1- or
1 th el oc alem er -
stopsfunctioning altogether. CPRaloneis not gencynum ber , ting
star CPRandusinganAED
e n o u gtoh h e l pso me o nsu e rvi ve car diacar r est. makes it lesslikelytheperson willsurvive.
Em e r g e nme cy d i cacal rei s n e e ded assoonas Remember, you,thelayresponder, arethefirst
possible. Thisiswhyit is soimportant to call linkintheCar diac Chain of Sur vival .

**rdi** [m*rg*n*i** | ?$
SOFTTISSUE
INJURIES
INJURIES lf youanswered"No"to twoor moreques-
tions,consider thegeneral
reviewing safety
tips
TheLeadingGausesof Workplace inAppendix C.
Injury-Related
Death
. Mo tove
r h i clien ci d e n ts
. H o mi ci d e s SOFT
TISSUE
INJURIES-
. Falls TYPES
OFWOUNDS
. Accidents withmachinery
. Softtissues arethelayersof skinandthefat
Injuriesfromfallingobjects
. andmusclebeneath theskin'souterlayer. Any
Electrocutions
timethesofttissues aredamaged or torn,the
Workplace InjuryPrevention Survey body isthr eatened. Injur ies
m ayda m age the
soft tissues at or near theskin'ssurface or deep
donotjusthappen.
Injuries Forthemostpart,
inthebody. Severbleeding
e canoc c uratthe
theyarepredictable andpreventable. lf you
skin'surs face andunderit,wher ei t i s har der to
havenotalready doneso,takethe"lnjuryPre-
detect. Germs cangetintothebodythrough a
ventionSurvey" below. Thesurvey willhelp
scr ape, cut,puncturor e bur nandc aus ei nfec -
makeyoumoreawareof conditions or situations
tion.Bur nsar ea special kindof so ftti s s ue
aroundyouthatmayleadto injury. lt alsomay
injury, Likeothertypesof softtissueinjury,
helpyoureduce yourriskof injury, aswellas
bur nscandam age thetoplayerof s k i northe
yourriskto others.
skin and the layer s fat,muscle
of andbone
Check the"Yes"or "No"boxnextto thefol-
beneath.
lowingquestions:
Wounds area physical injuryinvolving a
YesN o br eakinthelayer ( of s)theskin.W o unds ar e
T n Do you wear a safety belt when driving usually classifiedas either closed or open.
o r ri d i n g
i n a co mp a nmotory vehicle?
x n Doyourefrain fromdriving afterdrink- Glosed Wound
i n ga l co h o lbi ce ve ra g es? ln a closed wound( i.e., br uise,
inter nal bl eed-
tr n Do the stairs where you work have ing), the skin'ssurface is notbroken and the
h a n d ra i l s? damage to softtissueandbloodvessels hap-
n n Do you use a stepladder or sturdy stool pens below the sur face, wher ebleedi ng
s om e-
to reachhigh,out-of-reach objects? tim esoccur s.
tr I D o yo u h a ve a d e q u a l
tei ghting in halls B R U T S( 0ERC 0 N T U S f 0 N )
andstairways?
tr I D oyo uu seg o o dl i fti ntechniques
g
whenliftingobjects?
n f D oyo uw e a ra na p p ro pr iate helmet
w h e nu si n ga b i cycl emotor , cycle
or
scooter?
f n Doyouweara lifejacket whenpartici-
patinginworkactivities onor around . ' Bleeding under theskinis caus ed bydam -
thewater? ageto softtissues andbloodvessels.
tr n Doyouwearsafetyprotection (e.9., . ,Theareamaychange fromredto darkred
goggles, hearing protection) andfollow or pur ple.
e q u i p mesa n t fe ty
re co m m endations . A lar geor painful br uise maysi gnal s ev er e
(e.9., Lock0uVTag 0ut)? damage to deeptissues.

$ c f l T i s s u el n j u r i e si 3 1
 S I G N A TOSFI N T E R N ABT[ E E D I N G . Dirtandothermattercanenterthe
. Tender, swollen, bruised or hardareasofthe wound;cleaningthewou ndi s i m por tant
to
b o d y, su cha sth ea b d o men preventinfection.
. R a p i dw,e a kp u l se
. S ki nth a tfe e l sco o o
l r moistor lookspaleor LACERATION
b l u i sh
. V o mi ti nbgl o o do r co u g hing upblood
. Excessive thirst
. B e co mi nco g n fu sefa d ,i nt,dr owsy
or uncon-
sci o u s
CARE F O RM I N O RC L O S EW DO U N D
. A p p l yd i re ctp re ssu re . . Cutsbleedfreely,
. Elevate anddeepcutscanbleed
theinjured bodypartif it doesnot severely.
ca u semo rep a i n . . Deepcutscandam age
. A p p l yi ceo r a co l dp a ck(Fig. n er v esl ar
, ge
9- 1) . bloodvesselsandothersofttissues,
o Wh e na p p l yi ni ceg o r a chemical cold
p a ck,p l a cea g a u ze p ad,towelor other AVUTSION
clothbetween thesourceof coldandthe
person's skin.
o L e a ve th ei ceo r co l dp ackonfornomor e
th a n2 0mi n u tels. f co ntinued icingis
needed, remove thepackfor20minutes
a n dth e nre p l a ce
i t.
lf theperson complains ofsevere painor can-
notmovea bodypartwithoutpainor if youthink . A cutinwhicha pieceof softtissueor
theforcethatcaused theinjury wasgreatenough evenpartofthebody, suchasa finger,
t o ca u sese ri o udsa ma gse e , ekmedicalcar e. istornlooseor istornoffentirely
(i.e.,
amputation).
. Often,deepertissues ar edam aged,
causingsignificantbleedi ng.
PUNCTURE

0penWounds
I nano p e nw o u n d(i .e .,
cu t,sc r apes,
lacer ations,
avulsions), theskin's surface is brokenandblood
m ayco meth ro u gth h ete a ri ntheskin. Puncturewounds oftendonotbleeda lot
andcaneasilybecome infec ted.
ABRASION Bleedingcanbeseverwi e thdam age to
majorbloodvesselsor int er nal
or gans .
Anembedded objectinthew ounds houl d
ber em oved
onlybyadva nc ed m edi c al
per sonnel.
CARE F O RA M I N O R0 P E NW O U N DI nm i n o r
openwounds, suchasabr asions , ei s onl ya
ther
. S ki nh a sb e e nr:u b b eodr scr aped away, sm allamount of damage andble edi ng.
T oc ar e
( i.e.,
th ea re au su a l li ys p a i nful scr ape, fora m inorwound, followthesegener al
ro a dra shru, gb u rn ). guidelines:

3 ? i f i r s t & ; C l i l p R l & ifl * r t h * W * : " k p l * cFen r r i * i p a n rW

' ** r k h * * k
 Usea b a rri ebre tw e eyo n u rhands andthe withinthefirstfew hoursaftertheinjury.
wo u n dl .f re a d i layva i l a b lpe, utondispos- Stitches inthefacear eoftenr emov ed i n l es s
a b l eg l o veasn dp l a cea ste rile dr essing
on thana week.Injoints, theyareoftenremoved
t hew o u n d . after2 weeks.Stitches onmostotherbody
Applydirectpressure for a fewminutes to par tsr equir reem oval
in 6 to 10da y sSom
. e
c o n troaln yb l e e d i n g . stitches dissolvenatur allyanddonotr equi r e
Wa shth ew o u n d th o ro u g hly withsoapand r em oval.
water.lf possible, irrigate for about5 min-
uteswithclean,running tapwater.
;
Applytripleantibiotic ointment or creamto a
mi n ow r o u n di f th ep e rsohnasnoknown
a l l e rg i eosr se n si ti vi tito s medication
ethe
( Fi ge. -2 ).
Cover thewoundwitha steriledressing and -
b a n d a g(o e rw i tha na d h e sive bandage) if it
l l e e d i nslgi g h tloyr i f thear eaofthe
i s sti l b Thefollowing majorinjur ies oft enr equi r e
woundis likelyto comeintocontact with stitches:
. Bleeding fr omanar ter or y unc ontr ol l ed
d i rto r g e rms.
bleeding
. W ounds thatshowm uscle or b one,i nv ol v e
joints, gapewidelyor involve h ands orfeet
. Lar ge or deep punctur e
woun ds
. Lar ge or deeply embedded obj ec ts
. Human or anim al bites
. Wounds that,if leftunattended, couldleave
conspicuous scar s, suchasthos eonthe
face
lf youar ecar ing for a wounda ndthi nki t
CARE F O RA M A J O R OPEN WOUND mayneedstitches, it pr obably doesOnc. e
. Co n trobl e e d i nbgyp l a ci nagcleancover - applied, stitches canbeeasilycared for by
i ng su
, cha sa ste ri l d e re ssing,
overthe following thehealthcar epr ovide ri 's ns tr uc -
w o u n da n da p p l yi npgre ssur e. tions.lf thewoundgetsr edor swol l en or i f
. A p p l ya b a n d a gsn
e u g loyverthedr essing. pusbegins to for m,thehealthcarepr ov i der
. C a l9l - 1 - 1 . should benotified,
. Wa shyo u rh a n d ismme d i ately aftercom-
pl e ti nca
g re . Burns
. Burnsarespecial typesof softtissue
A S t i tch i n T i me injur ies.
l t j u d g ew h e na wound
I t c a nb ed i ffi cuto . Bur nscandam age oneor m orel ay erof
s
s h o u l re
d ce i vesti tch e s. 0 n eru l eofthum bis skinortheskinandthelayeros ffat,m us c l e
t h a ts ti tch easren e e d ew d h e nedgesof skindo andbonebeneath.
n o tf al lto g e th eth
r,el a ce ra ti oi nvolves
n the Bur nsar ecausedby-
f a c e .owr h e na n yw o u n di s o ve r72inchlong. . Heat.
Sti tch esp s eed th eh e a l i npr
g ocess, lessen . - Chem icals.
t h ec h a n ceosf i n fe cti oann di mpr ove the . Electricity.
a p p e a r a nocfes c a r sT. h e ys h o u l bd ep l a c e d . Radiation( sun) .

$ * f tT i s s u l*n l u r i * s| 3 S
 TYPES O FB U R N S G r i t i c aBl u r n s
. Superficial Burn(firstdegree) Cr itical bur nsr equirm e edical attenti on. T hes e
o Involves onlythetoplayerof skin. burnsarepotentially lifethreatening, disfiguring
o T h eski ni s re d d
, ry,a ndusually
painful anddisabling. Evensuper fic ibur al nsc anbe
a n dth ea re ama ysw ell. criticalif theyaffecta largeareaor certain
. Usually healswithina weekwithoutper- bodyparts. Youcannot judgea burn's severity
ma n e nsca
t rri n g . bythe pain thatthebur ned pe r s onfeel s
because ner veendings m ayb edes tr oy ed. You
should always call9- 1- 1 orthel oc alem er genc y
num ber if ther ear e-
. Bur ns thatcausetr oublebr d eathi ng.
. Bur nscover ing mor ethanonebodypar tor
a lar gesur face ar ea.
. Bur ns to the head, neck,handsfeet , or
PartialThickness (second degree)
. Involves thetoplayers of skin. genitals.
. T h eski ni s re d u . Bur ns to theair way( burns to them outh
painful;
; su ally hasblis-
te rsth a tma yo p e na ndweepclearfluid, and nose may be a signal ofthi s ) .
. B u r n (so t h et rh a na v e r ym i n oor n e ) t oa
ma ki nth g eski na p p ear wet;mayappear
mottled; andoftenswells. c h i l d( y o u n gtehra na g e5 )o r a ne l d e r l y
. U su a lhl ye a l isn3 to 4 weeksandm ayscar . per son ( olderthanage60 ) .
. Bur nsr esulting fr omchemi c alex s ,pl os i ons
or electricity.
A criticalburncanbe lifethreatening and
needsimmediate medicalattention. Gallg-1-l
or thelocalemergency number.
(Heat)Burns
GareforThermal
FullThickness (thirddegree) . Check thesceneforsafety .
. Ma yd e stroayl ll a ye rof s skinandsomeor . Stopthebur ning theper s on
byr em ov i ng
alloftheunderlying structures-fat,mus- fr omthesour ce ofthebu r n.
cl e s,b o n e as n dn e rves. . Check forlife- thr eatenic ng
ondi ti ons .
. T h eski nma yb eb ro wnor black( char r ed) . Coolthebur nwithlar geam ounts of c ol d
withthetissueunderneath sometimes r unning wateruntilpainis r el i ev ed.
a p p e a ri n
wgh i te . . Cover thebur nloosely witha s ter i l e
. C a ne i th ebr ee xtre mely painful
or r ela- dr essing.
tively painless (iftheburndestroys nerve . Pr event infection.
endings), . Takestepsto minimize shoc kKeep
. the
. H e a l i nma
g yre q u i re medicalassistance; per son fr omgetting chilled
or ov er heated.
scarring is likely. . Comforand t r eassurthe
e per s on.
Garefor Ghemical
Burns
. Thechem ical willcontinuto
e bur nasl ong
asit is ontheskin.Youmustremove the
'
chem ical fr omthebodyasqui c k las
y
possible.

3 4 i i : i r * tA i * l i l i l f t l & f i *f * r r h * W * r k p l * c * P * r r i * i p x n r 'W
s *:'kb*nk
 theburnwithlargeamounts
Flush of cool
water.Continue
running theburnfor
flushing
atleast20minutes
or untilemergencymedical
services(EMS)
personnel (Fig.
arrive 9-3).

{Sun}Burns
Garefor Radiation
. Car eforsunbur ns
asyouwouldanyother
bur n.
D r ych e mi cath l sa tca u seb u rns should be . Cooltheburnandprotecttheareafromfur-
b ru sh eodffth eski nu si n g l oved hands therdamage it outofthes un.
bykeeping
b e fo re being fl u sh ew d i thta pwater( under
p re ssu reb), e i n gca re funl o ttogetthe WhenGaring for a Burn,D0 NOT-
c h e mi ca on (
l yo u rseol frth ep er son 9- a) .Fig. . Applyiceor icewaterexceptona small,
super ficialbur nandthenfornom or e
than10minutes. lcecancause t hebody
to loseheatandfur ther dam ag es del i c ate
tissue.
. Toucha burnwithanything excepta clean
cover ing.
. Reinove pieces of clothing thatstickto the
bur ned ar ea.
. l f p o ssi b lhea, veth ep e rso remove n . Try to clean a severe burn.
. Breakblisters.
c o n ta mi n a te cl o d th etos p re vent fur ther
. Useanykindof ointment ona severe burn.
c o n ta mi n a tiwohni l eyo uco ntinue to flush
t h ea re aw i thco o lru n n i nw g ater .
. B ea w a r e t h a tc h e m i c acl sa nb ei n h a l e d , Preventing Burns
p ote n ti a d l la
y ma g i nthgea i rwayor lungs. . Heatburnscanbeprevented byfollowing
safetypractices thatprevent fireandby
Garefor Electrical Burns beingcar eful ar ound sour ces of heat.
. N e vegr on e a ra p e rsow n i thanelectr ical . Chem ical
bur nscan be pr even ted
byfol l ow -
burnuntilyouaresuretheperson is notstill ingsafety pr actices ar ound allc hem i c al s
in contact withthepowersource. and by following m anufactur gui
er s 'del i nes
. Inthecaseof high-voltage electrocution, whenever handling chem icals .
s u cha sth a tca u sebdyd o w ned power lines, . Electrical burns can beprevented byfollow-
c al l9 -1 -1 o rth el o cael me rgency num ber . ingsafety pr actices ar ound elec tr i clal
i nes
. Turnoffthepowerat itssourceandcarefor andequipm ent andbyleaving o utdoor ar eas
anylife-threatening conditions. whenlightening couldstr ike.
. Ane l e ctri ca b ul rnma yse ve rely dam age . Sunbur can
n be pr evented byw ear i ng
u nd e rl yiti n ssu
g e (F i g9. -5 ). lPPropriate clothing andusingsunscreen.
. El e ctro cu tica o nnca u seca rdiac and Sunscr een
should have a sunpr otec ti on
b re a th i negme rg e n ciB ep repar ed
e s. to factor (SPF) of at least15.
g iveca rd i o p u l mo nre a su
ry s citation or defib-
r i ll a ti oC
n .a refo rsh o cka n dther m al bur ns. [ightning
. Al lp e o p lw e i the l e ctrish c o ckr equir e Traveling at speeds upto 300milespersecond,
a dva n ceme d d i caca l re . a lightningstr ikecanhur a l per son t hr ough the

$ n f tT i s * u *l n j u r i * sI 3 *
air.lt canburnoffclothes andcansometimes
causetheheartto stopbeating. Themostsevere
lightning strikes carryupto 50million voltsof
electricity, enough to serve13,000 homes. Light-
ningcan"flash"overa person's bodyor it can
t r a v e l t h ro ubglho o d ve sse lasn dn e rves to r each
t h eg r o un d .
Be s i d ebsu rn s, l i g h tn i ncag na l socause
n e r v o usyste
s md a ma g e b ,ro kebno nes andloss Howto Prevent an Infection
of hearing or eyesight. People sometimes act . Washhandsbeforeandaftercaringforthe
confused andsuffermemory loss.Theymay wound, evenif youweargloves.
d e s c r i be wh a th a p p e n eadsg e tti nhit g onthe . Washminorwounds withsoapandwater.lf
h e a do r he a ri nagne xp l o si o n . possible, irrigate withcleanrunning water
U s eco mmose n n se d u ri nthg u n der stor ms. for about5 minutes.
l f y o us e ea sto rma p p ro a ch iinng th edistance, . Donotwashwounds thatr equirm e edi c al
donotwaituntilyouaresoaked to seek attentionunless instructed to doso bya
shelter. medical pr ofessional.
lf a thunderstorm threatens,you should- . Coverthewoundwitha cleandr es s i ng and
. G oi nsi d a e l a rg eb u i l d i nogr h o me thathas bandages, whichshould bechanged dai l y .
f o u rso l i dw a l l sa n dp re fe ra bel lectr
y ical, . lf aninfection persists
or worsens, havethe
t e l e ph o naen dp l u mb i nl ign e s, w hichaidin per sonseekmedical car e.
groundin thgestru ctu re .
. G oi n si d a e ca ra n dro l lu pth ew indows. Do Signals of an Infeetion
nottouchanyofthecar'smetalframework . Thewoundar eabecomes swollen andr ed.
w h e ni nth eca r. . The ar ea m ayfeel war m or thr obw i thpai n.
. S t o ps w i mmi nogr b o a ti nagsso onasyou . Thear eam aydischar ge pus.
s e eor h e a ra sto rmb e ca u se . Red str eaks may develop ar oundth ew ound.
w a tercon-
ductselectricity. . The per sonm aydevelop a feveran dfeeli l l .
. Stayawayfromthetelephone, . Theper son should seek medical attenti on
exceptin an
e m e rg e n cy. foranydeveloping infections.
. N o tsh o w eor r b a th e d u ri n ag th under stor m .
. St a yaw a yfro mte l e p h o npeo l e sandtall CARE FORSPECIAL SITUATIONS
t r e e si f yo ua reca u g hot u tsi d e .
. Stayoffhilltops; tryto crouchdownin a
EyeInjury
r a v i ne o rva l l e y. Foranobject em bedded intheeye-
. S t a ya w a yfro mfa rme q u i p meand . D0 NOTattemptto remove anobject
nt small
m e t al ve h i cl esu s, cha smo to rcycles, bicy- em bedded intheeye.
. Place a ster ile
dr essingar ound theobj ecitn
c l e san dg o l fca rts.
. Avoidwirefences, wireclotheslines, some the eye; stabilize the object, suchaswitha
f i s h i nrog d s,me tapl i p e sa n dra i lsandother paper cup, for suppor t.
. Bandage loosely anddonotputpr e s s uron e
c o n d u cto rs.
. St a Vse ve ra l yaard theinjured eye/eyeball (Fig.9-7).
p asrti fyo ua reina gr oup.
. Seekim m ediate m edical attention.

INFECTION
PREVENTION
Harmfu p la th o g e (g
n se rms)ma ye n terthebody
t h r o u gshcra p e cus, ts,p u n ctu reosr bur nsand
causeinfection. Infection maydevelop within
hoursor daysof aninjury(Fig.9-64-B).

3 6 i $ i r s tA i * / { : fA l & F i lf * r i h * W r : r k p } * c F
* a r r i r i p a n t 'W
s *rkb**k
 givecareto m i ni -
is significant,
lf bleeding
mizeshock.
Wrapthesevered bodypartin sterilegauze
or a cleancloth.
Place thesevered bodypartin a plasticbag
(Fig.
s-e).
Puttheplasticbagonice(butdonotfreeze
it)andkeepit withtheperson.

Nosebleed
F o rsma lfol re i gbno d i eisnth eeyesuchas stepsto control
Takethefollowing a nosebleed:
s a n do r o th esma
r ldl e b ri s- . Havetheperson sitleaning forward.
slightly
. Telltheperson to blinkseveral timesto tryto . Pinch together
thenostrils for about
remove theobject. 10m inutes.
. Gently flushtheeyewithwater. . Applyanicepacktothebr idge ofthenos e.
. Seekmedical attention if theobjectremains. doesnotstop-
lf bleeding
F o rch e mi cailnsth ee ye - . Applypr essurone theupperlipjus tbeneath
. Flush theeyecontinuously withwaterfor thenose.
10minutes or untilEMSpersonnel arrives. . Sendsom eone orthel oc al
to call9- 1- 1
Always flushawayfromtheuninjured eye emer gency number if theper sonlos esc on-
(Fig. e-8). positiontheper son onthes i de
sciousness;
to allowbloodto drainfromthenose.
Embedded
Objects
. Donotremove theobject. Note:Seekmedical attention if thebleeding per-
. Ba nd a gbeu l kyd re ssi n ga sro und theobject sistsor recursor if theperson saysit results
to keepit frommoving. fr omhighbloodpr essur e.
. B a nd a gthe ed re ssi ni n gp l a ce.
. B e c a u se
sh o ck i s l i ke l iyf b l e eding
is sever e, Afterthebleeding stops-
. Have theper son avoidr ubbing, b l ow i ng
or
g i veca reto mi n i mi ze sh o ck.
picking thenose,whichcouldrestart the
Severed BodyParts bleeding.
Takethefollowing stepsto carefor a person
sufferingfroma severed bodypart:
lnjuriesto theMouthandTeeth
. C o n trobl e e d i n g . lf noser ious head,neckor backiniur iys s us -
. Wrapandbandage thewoundto prevent pected-
. Rinse outthemouth withcoldtapwaterif
infection.
available.
. Havetheperson leanslightly forwardor
placethe per sononhisor hersid e.
. Trytopreventthe person fromswallowing the
blood, whichmaycause nausea or vomiting.
' Applythedressing.
o Forinside thecheek- place fo l deds ter i l e
!ressinginside themouthagainst the
wound.
o Foroutside thecheek-apply directpres-
' sur eusinga ster ile
dr essing.
o Forthetongue or lips-apply directpres-
sureusinga sterile dressing. Applya cold
compress to reduce swelling andeasepain.

$ * f t T i s * r : *i n l u r i * sI 3 ?
TEETH K N OC K EOU D T lf organs arenotexposed-
. Rinse outthemouthwithcoldtapwaterif . Keeptheperson lyingdownwithknees
a vai l ab l e . bent,if that position doesnotcausepain.
. Havetheperson bitedownona rolledster- o Puta folded blanket or pil l owunder the
iledressing inthespaceleftbythetooth knees to support theperson inthis
(o rte e th ). position,
. S a vea n yd i sp l a cetede th. . Givecar eto minimize shoc k .
o Carefully pickupthetoothbythecrown
(whitepart),nottheroot. A n i m aBl i t e s
o Rinseofftherootofthetoothin waterif it lf thebleeding is severe-
is dirty.Donotscrubit or remove any . Contr ol bleeding
attached tissuefragments. . Call9- 1- 1 orthelocalem ergenc y ber
num
o P l a ce th eto o thi n mi l k,if possible,
or especially if you suspect theani m al has
waterandkeepit withtheperson. r abies.
. Gettheperson to a dentist assoonaspossi- . Reporthe t incident to theloc alani m al -
ble (within 30to 60minutes aftertheinjury). contr ol officer or police.
. Check witha healthcareprovider whether a
Injuries to theAbdomen tetanus booster maybenecessary.
l f o rg a nasree xp o sei n d a no penwound- lf thebleeding is minor -
. D on o ta p p l yp re ssu to reor gans or push . Contr ol bleeding.
th e mb a cki n si d e . . Washthewoundwithsoapandwarmwater.
. Keeptheperson lyingdownwithhisor her lf possible, ir r igate withcleanr unni ng tap
kneesbent,if thatposition doesnotcause waterfor about5 minutes.
pain. . Applytr iple antibiotic ointm ent or c r eami f
o P u ta fo l d e d b l a n keotr pillowunder person hasnoknownallergies or sensitivi-
theknees to support theminthis tiesto themedication,
p o si ti o n . . Cover thewound.
. Remove anyclothing fromaround the . C a l9l - 1 - o1 r t h el o c ael m e r g e nncuym b ei fr
wound. yoususpect theanimal hasrabi es .
. Loosely applymoist, steriledressings or a . Reporthe t incident to thelo c alani m al -
cl e a ncl o tho ve thr ew o u nd. control officeror police.
. Keepthedressing moistwithwarmwater. . Check witha heathcareprovider whether a
. P l a ce a cl o tho ve thr ed ressing to keep tetanus booster maybenecessary.
o rg a nw s a rm.
. Gi veca reto mi n i mi ze sh ock.

3 S I F i rstA ;d l i l P n l A n?i *r
l rhnW * r k p*l * * F a r t i * i p na t ' *\ { l * r k b * n k
 TOMUSCLES,
INJURIES
BONESANDJOINTS
I n j u r i eto s n dj o intscanoccur
s mu scl ebs,o n e a
i nt h ew o rkp l a ce a sa re su lot f a ccidents,
such
e sh e os,rfo rcedimpact
a sf a l l s,ve h i clcra with
e q u i pmeonrtma ch i n e ry.

OFMUSCIE,
TYPES BONE
ANDJOINT
INJURIES
. Fracture
o C o mp l ebtere a k, ch i po r crackin a bone
( F i g1. 0 -)1
o Caused byfall,blowortwisting movement . Strain
o 0 p e n(o p e w n o u n do) r cl o sed( skinnot o Str etching andtear ing of m us c l es
or
b ro ke n ) ( Fig.
tendons 10- 3B)
o Canbelifethreatening if it involvesa o Oftencaused byliftingor overwork
, cha sth eth i gh;
l a rg eb o n esu severan s o Usually involves m uscles inthenec k ,
artery; or affects breathing back, thigh, shoulder or lowerl eg
It is difficult to knowif a muscle, boneor
jointinjur is y a fr actur e,
dislocati on,s pr ai or
n
strain. lt is notnecessary to know the type of
injury; thecaregivenisthesamewhether the
y a fr actur e,
injur is dislocation, sprai orn s tr ai n.
Gener al car eincludes followi ngR .| .C .E.-
. Rest-Donotmoveor straighten theinjured
ar ea.
. lm m obilize- Stabilize theinjured ar eai nthe
position found. Splinttheinjured par t0N LY
if theperson mustbemoved andit doesnot
cause mor epain.
. Cold-Filla plastic bagor wrapicewitha
dampclothandapplyiceto thei nj ur ed ar ea
for periods of about20minutes. lf continued
icingis needed, r em ove thepa c kfor20m i n-
Dislocation it.Place a thi nbar r i er
utesandthenr eplace
o Movement of a boneat a jointawayfrom between theiceandbar eskin .
th en o rmaplo si ti o(F n i g1. 0- 2) , . Elevate-D0NOTelevate theinjured partif
o Moreobvious thana fracture it causes m or epain.
o Often formsa bump,ridgeor hollow
Sprain SIGNALSOFMUSCLE,BONE
o Tearing of ligaments at a joint(Fig.10-3A)
o Ma ysw e lal n dca ni n vo l ve fr actur es
or ANIIJOINTINJURIES
d i sl o ca ti o n s Always suspect injur when
a ser ious y anyofthe
o Mostoftenoccursintheankle, knee, following
signalsar epr esent:
j
w ri sto rfi n g e ro i n t . Significant
deformity.

i r : i * r i * t** i l { L r s * l *l *} *, r : * ** * d " J * i n t sI 3 *
 HEAD,NEGKANDBACKINJURIES
S i g n a los f H e a dN, e c ka n dB a c k
Injuries
. Change in consciousness
. Severpain
e or pr essurin ethehead, nec kor
back
Tinglingor lossofsensation inth ehands ,
fingers,feetortoes
FOR
GARE RIB/BREASTBONE or complete
Partial lossof movement of any
FRACTURES bodypart
. Pl a ce Unusual bum psor depr essionsonthehead
a pillow o rfo l d e d between
b l a nket the
d b sa n dth ea rm(F i g10-
i n j u reri . 7) . or overtheneckandback
. Bindthearmto thebodyto helpsupport the
a Blood or otherfluidsintheear sor nos e
a Heavy exter nalbleedingoftheh ead, nec kor
i n j u readre a .
back
a Seizur es

a lmpair ed orvision
br eathing asa r es ulof
t
injury
a Nausea orvomiting
a Per sistentheadache
a Loss of balance
a Br uisingofthehead, especialarl youndthe
eyesandbehind theear s

Whento Suspect Head,Neck

o r B a c kI n j u r i e s
FRACTURE
OPEN a head, ne c kor bac k
Youshould alsosuspect
An openfracture occurs whena boneis severely injuryif theperson-
i n j u r ed
ca g eb o n ee n d sto tearthr ough
, u si nth . W asinvolved in a motor vehic lcer as h.
t h es ki na n dsu rro u n d itinssu
g e (Fig.
10- 8) . . W asinjur ed asa r esultof a fallfr omgr eater
thana standing height.
. Repor ofts neckor backpain.
. Hastingling orweakness intheex tr em i ti es ,
. ls notfullyalert.
. Appears to beintoxicated.
. Appearto s befr ailor over65ye ar sof age.

Carefor Head,NeckandBack
Carefor an 0penFracture Iniuries
. C a l l 9 - 1o- 1
r t h el o c ael m e r g e nncuym b e r . . C a lol r h a v es o m e o ncea l l 9 - 1 o
- 1r t h el o c a l
. Place sterile dressings around theopenfrac- em er gency numDer .
tureasyouwouldforanembedded object. . Minimize m ovement ofthehead, nec kand
. Ba n d a gth e ed re ssi n gi nsp l acear ound the back.
fracture. . Minimize m ovement byplacinygour
. A vo i dmo vi nth g ee xp o sebdoneandlim b; hands onbothsidesofthepers on's head,
t hi sma yca u se th ep e rsoan gr eatdealof . Gently holdtheperson's headin linewith
p ai na n dma yco mp l i care tecover y. thebody.

! n j r L r !t*** l \ 4 * s * ! * f*i,* n * s* r r i Jl * ! n t sI ; X ' i

 lf theheadis sharply turnedto oneside,do
nottryto alignit withthebody;support the
headintheposition youfindit.
a Ma i n ta ianno p e na i rw ay.
a Monitor
airway, breathing andsignsof life.
a Control
anyexternal bleeding.
a Keep theperson fromgetting chilledor
overheated.
Wearing a helmet helpsprotect againsthead,
neckor backinjuries (Fig. 10-9A-C).However, if a
person witha suspected head, neckor backinjury
iswearing a helmet, donotremove it unless
it is
necessary to assess the person's airwayandyou
arespecifically trained to doso.Minimize move-
mentusing thesametechnique asiftherewere
noheadgear.

4 ? | F i r s tA i d i i l P t l A f ; rfus r t h e \ l d n r k p i * * a
P a r t i * r p * n t 'W
s r:rkba*k
SKILL ANAT0MIC
SHEET: SPtINT
CHECK forsafety.
thescene person
theinjured
CHECK following precautions.
standard CALL orthe
9-1-1
number
localemergency ToGARE
if necessary. fora personwhohasaninjured
limb-

STEP 1:0btainconsent.
S u p p oth andbelow
rt ei n j u readre aa b ove STEP 4:Place ar eanexto
theuninjur ed t the
thesiteoftheinjury. injur ed
ar ea.

STEP warmthandcolor,
forfeeling,
2:Check STEP bandages
5:Tietr iangular sec ur el y .

S T EP 3 :P l a ce
se ve rafol l d e tri
d angular band-
a g e sab o ve a n db e l o wth ei n j u red
ar ea. STEP forfeeling,
6:Recheck andc ol or .
war m th

lf youar enotableto checkwa r m th and

c o l obr e c a u saes o c ko rs h o ei si n p l a c ec,h e c k
forfeeling.
i:* t;i ir,i, lJ* I *;: ;;r tl J * i t;ls I $i
i * ! i;:-i* r'l * l,-tl
SKILT
SHEET
APPLYING
A SOFT
SPLINT
CH E C K th e ne
sce fo rsa fe ty.
CHEGKthe per son
injur ed following
standarpr
d ecau ti ons . 9- 1- lor
C ALL
th el o cael me rg e nncy
u mber if necessarTo
y.CAREfora per son
whohasaninjur eldi m b-
ST E P
l :0 b ta i nco n se n t.
S u p p o rtthi nej u readreaabove
andbelow STEP wrapa softobject(afoldedblan-
4: Gently
thesiteoftheinjury. ketor pillow)
ar ound
theinjur ed
ar ea.

STE2
P: C h e ck
fo rfe e l i n gwar
, mth
andcolor . STEP
5:1ietriangular
bandages
securely
withknots.

STEP6:Recheck forfeeling,
warmth lfyou
andcolor.
ST E 3P: P l a ce
se ve rafol l d edtr iangular
band- arenotableto checkwarmth andcolorbecause a
ag e sa b o vea n db e l o w
th ei njur ed
ar ea. sockorshoeisinplace,check forfeeling.
SKILL
SHEET: A SIINGANDBINDER
APPLYING
CHECK thesceneforsafety. CHECK person
theinjured following precautions,
standard CALL9-1-1or
u mb ei frn ecessarTo
t h el o cael me rg e n ncy y.CAREfora per son
whohasan iniur limb-
ed

STEP 1:0btainconsent. STEP areato thechestwitha

5:Bindtheinjured
andbelow
S u p p o rtthi nej u readre aa b ove folded bandage.
tr iangular
thesiteofthe injury.

STEP
2:Check warmthandcolor.
forfeeling,

S T EP 3 :P l a cea tri a n g u l b
aar n dage the
under
i n j u r eadrma n do ve th r eu n i n j ur ed to
shoulder
f o r ma sl i n g .

S T EP 4 :l reth ee n d so fth esl i n gatthesideof

t h en e ck.

5:Recheck
STEP warmthandcolor.
forfeeling,

i * j r i r i * * t * M t , t s * r 1 **1* t, q : * * r * . i * i * l s I S$
 SKIttSHEET
APPTYING
A RIGID
SPIINT
CHECK thesceneforsafety. CHECK theinjured
personfollowing precautions.
standard CAtt9-l-1or
th el o cael me rg e n ncy
u mber
if necessarTo
y.CAREfora per son
whohasaninjur ed
l i m b-

ST E P
l :Ob ta i n
co n se n t.
S u p p o rtthi nej u readreaabove
andbelow STEP
4:Tiesever al
folded
tr iangul bandages
ar
thesiteoftheinjury. above
andbelowtheinjur edar ea.

STEP
2:Check
forfeeling,
warmthandcolor. STEP
5:Recheck
forfeeling,
war m th
andc ol or .

STE3 P:P l a ce ( boar d)

th eri g i dsp l i nt lf a r igidsplintis usedona for ear m y ou
,
under
the
i n j u readre aa n dth ej o i n ts
thatar eabove m ustalsoimm obilize theelbowBi , ndthear mto
and
below th ei n i u readre a . thechestusing folded tr iangul bandages
ar or
a p p la
ysling.

4 # i i l i r s t& ! * l * f n l A f * f * r t ; : * ! ? * r ' k r l * r : *f * r l i * i p * * ? ' *l f f r r l s h r : { r k

 ILLNESS
SUDDEN
Youmaynotknowtheexactcauseof a sudden . M onitor
br eathing
andconscio us nes s .
b u tth i ssh o u l nd o tke e pyoufr omgiving
i l l n e ss, . Helptheperson restinthemostcomfortable
c a r eGe . n e ra lal y, p e rsow n i thsu ddenillness position.
l o o k san dfe e l si l l .l f yo uth i n kso mething
is . Keeptheperson fromgetting
chilled
or
w r o n g, ch e ckth ep e rso n A.p e rson m aydeny overheated.
anything is seriously wrong.Donotbeafraidto . Reassur e per son.
the
asktheperson questions. Theperson's condition . Giveanyspecificcar eneeded.
canworsenrapidly if heor sheis notcaredfor.
S u d d einl l n e ss i n cl u d e s- FAINTING
. Fainting.
. D ia b e tiecme rg e n cy. W hensomeone suddenly losescons c i ous nes s
. Se i zu re . andthenreawakens, heor shemaysimply have
. Stroke. fainted.Fainting
is notusuallyharmful andthe
. Po i so n i n g . person willusuallyquickly recover.
Lower the
. A l l e rg ire person to theground or.otherflatsurface and
c a cti o n .
positiontheperson onhisor herback.lf possible,
raisetheperson's legs8 to 12inches. Loosenany
SIGNALS ILTNESS
OFSUDDEN tightclothing,
suchasa tieor collar. Check to
W h e na p e rsobne co mesu s d d e nlyill,heor she makesuretheperson Donotgive
is breathing.
u s u a lll yo o ksa n dfe e l ssi ck.C o mm on signals theperson anythingto eator drink.lf theperson
include- vomits,position
theperson onhisor herside.
. C ha n g ei nsco n sci o u sn esuch s s, asfeeling
l i gh t-h e a doerd i zzy, o r b e coming uncon- DIABETIC
EMERGENCY
s ci o u s.
. N au seoar vo mi ti n g . People whoar ediabetic som etimes bec omiel l
. Difficulty because ther eistoom uchortoolittl es ugari n
speaking or slurred speech
. N umb n e oss theirblood. M anydiabetics usedietex , er c i sore
rw e a kn e ss.
. Lossofvisionor blurred medication to contr oltheir diabeteYou s . m ay
vision.
. C ha n g ei nsb re a th i nth knowtheperson is a diabetic ortheperson may
g ;ep e r son m ayhave
tellyouheor sheis a diabetic. Often, diabetics
t r ou b l be re a th i nogr ma yn o tbebr eathing
knowwhatis wrongandwillaskfor something
normally.
. C ha n g ei nsski nco l o (p withsugarin it or maycar r ysom efo r mof s ugar
r a l ea, s hen or
withthem.
f l u sh eski
d n ).
. Sweating. lf thediabetic per son is consc i ous and
. Persistent cansafelyswallow foodor fluids, hi m g i v e
pressure or pain.
. D ia rrh e a . or hersugarpr , efer ably in liquidform M . os t
. Se i zu re s. fr uitjuicesandnondiet softdr inkshav e
. Paralysis enough sugarto beeffective. Youcanal s o
or inability to move.
. Se ve re givetablesugardissolved in a glas sof w ater .
h e a d a ch e .
lf theper son'pr s oblem is lowbloods ugar ,
suga.r will help quickly. lf thepr obl em i s too
CARE
FORSUDDEN
ILLNESS muchsugarthe , sugarwillnotcau s eanyfur -
. Donofurtherharm. t h e rh a r m .
. C he ck th esce n e fo rcl u e sa b out
whatmight A l w a ycsa l l 9 - 1 o
- 1r t h el o c ael m e r g e n c y
, e nch e ckth ep e rson.
b ew ro n gth number if-
. C al9l -1 -1
o rth el o cael me rgency numberfor . Theper son is unconscious or aboutto l os e
life-threaten ing conditions. consciousness.
S , ' r d d *l ni l n e s s| 4 7
 . T hep e rsoins co n sci o uasn dunable
to
swallow.
. Theperson doesnotfeelbetterwithin
about5 minutes aftertakingsugar,
. Yo uca n n ofit n dsu g airmme diately.
Do
notspend timelooking for it.

SEIZURES
Carefora person whohashada seizure
thesamewayyouwouldforanyuncon-
scious person. Toprotect theperson frombeing
injured, remove anynearby objects thatmight
causeinjury. Protectthe person's headbyplacing . Haveblur r ed or dimm ed vision .
a thincushion underit.Folded clothing makes an . Exper ience a sudden, sever headac
e he;
adequate cushion. lf thereisfluidintheperson's dizziness;or confusion.
mouth, suchassaliva, bloodorvomit, rollhimor
herononesidesothatthefluiddrains fromthe F.A.S.T. Recognition of Stroke
mouth. Fora StrokeThinkF.A.S.T.
Whentheseizure is over,theperson will . Face-Weakness ononesideoftheface
u s u a l lbye g i n to b re a thneo rma l ly. Heor she o Asktheperson to smile;thiswillshowif
m a yb ed ro w sy a n dd i so ri e n teo rdunr esponsive ther eis dr ooping orweaknesi nsthem us -
f o ra p e ri o o d fti meC . h e ck
to se ei f theper son clesononesideoftheface.
w a si n j u reddu ri n th g ese i zu re B.er eassur ing . Arm-Weakness or numbness in onearm
a n dc o mfo rti nl g . ese i zu re
f th o ccur r ed in pub- o Asktheperson to raisebotharmsto find
l i c ,t h epe rsoma n yb ee mb a rra ssed andself- outif thereisweakness inthelimbs.
c o n s ci o uAs.skb ysta n d enrs o tto c r owdar ound . Speech-Slurred speech ortrouble getting
t h ep e r so nH. eo r sh ew i l lb eti re dandwantto
thewordsout
rest.Staywiththeperson untilheor sheis fully o Asktheperson to speaka simple sentence
c o n s c i o uasn da w a reo f h i so r h e rsur r oundings.
to listenforslurred or distortedspeech
(e.9.,I havethelunchorders ready).
STROKE . Time-Timeto call9-1-1if youseeanyof
. A stroke, alsocalleda brainattack, is a thesesigns
blockage of bloodflowto a partofthebrain. o lf a person hasdifficulty withanyofthese
I t ca nca u sep e rma n ednat mage to thebr ain tasks or shows any other signals of a
if thebloodflowis notrestored. stroke, notethetimethatthesignals
. A s tro ke ca nb eca u sebdya b loodclotor began andcall9- 1- 1 r ightawa y .
bleeding froma ruptured arteryinthebrain
( F i g1.1 - 1 ) .
POISONING
Sudden
Signals
of Stroke A poison is anysubstance thatcancaus ei nj ur y ,
Aswithothersudden illnesses, theprimary sig- illness or death whenintr oduced intothebody
nalsof a strokeor mini-stroke area sudden ( F i g1. 1 - 2 A - D ) .
c h a n ge i n h o wth eb o d yi sw o rki nor g feeling. lf yoususpect thata per son is show i ng
T h i su su a l li yn cl u d esu
s d d ewn e a k ness
or signals of poisoning, callthePoisoC n ontr ol
n u m b ne o ssfth efa cea, rmo r l e g .Usually, weak- Centerat800-222-1222.lt thepersonis uncon-
n e s so r nu mb n e o ssccu rs o n l yo nonesideofthe scious, ther eis a change intheleveof l c on-
body.In addition, theperson may- sciousness or if another life- thr eateni ng
. Havedifficulty talking or beingunderstood c o n d i t i oi snp r e s e nct a
, l l9 - 1 - o
1 rt h el o c a l
w h e nsp e a ki n g , emer gency number .
r t h * 1 # * r k p l a * *P * r t i * i p * n t ' s1 . $ / * r k i : r * k
4 S I f ! r * t & 1 i j / f ; F f f i i Afi*l S
 /t)

. T h epe rsoins co n sci o uasn du n able

to
swallow.
. Theperson doesnotfeelbetterwithin
about 5 minutes aftertakingsugar'
. Y o uca n n ofit n dsu g airmme d i ately.
Do
notspend time looking for it.

SEIZURES
Carefora person whohashada seizure
thesamewayyouwouldforanyuncon-
scious person. Toprotect theperson frombeing
injured, remove anynearby obiects thatmight
causeinjury. Protectthe person's head byplacing . Haveblur r ed or dim m edvision.
a thincushion underit.Folded clothing makes an . Exper ience a sudden, sever hea
e dac he;
adequate cushion, lf there is fluid in the person's dizziness;or confusion.
mouth, suchassaliva, bloodorvomit, rollhimor
herononesidesothatthefluiddrains fromthe F.A.S.T. Recognition of Stroke
mouth. Fora StrokeThinkF.A.S.T.
Whentheseizure is over, the person will . Face-Weakness ononesideoftheface
u s u a l lbye g i n to b re a thneo rma l lHe y , or she o Asktheperson to smile; thiswillshowif
m a yb edro w sy a n dd i so ri e n te d o r unr esponsive ther eis dr oopingorweakness inthem us -
f o ra p e r i o o d fti me C . h e ck to se ei f theper son cleson one side ofthe face.
w a si n i u reddu ri n th g ese i zu re B.ereassur ing . Arm-Weakness or numbness in onearm
a n dc o m fo rti nl fgth . ese i zu re o ccur r ed in pub- o Asktheperson to raisebotharmsto find
l i c ,t h epe rsoma n yb ee mb a rra ssand ed self- outif thereisweakness inthelimbs'
c o n s c i o uAs.skb ysta n d enrs o tto cr owdar ound . Speech-slurred speech ortroublegetting
the p e r so n .
H eo r sh e w i l lb eti re d and want to thewordsout
rest.Staywiththeperson untilheor sheis fully o Asktheperson to speaka simple sentence
c o n s c io uasn da w a re o f h i so r h e rsur r oundings. to listenforslurred or distortedspeech
(e.g.,I havethelunchorders ready).
STROKE . Time-Timeto call9-1-1if youseeanyof
. A stroke, alsocalleda brainattack, is a thesesigns
o lf a person hasdifficulty withanyofthese
b l o cka goef b l o o d fl o wto a p a r tofthebr ain.
tasksor showsanyothersignals of a
I t c anca u sep e rma n ednat mage to thebr ain
stroke,notethetimethatthe signals
if thebloodflowis notrestored.
. A s tro ke began and r ightaway .
call9- 1- 1
ca nb eca u sebdya b l oodclotor
bleeding froma ruptured arteryinthebrain
( F i s1. 1 - 1 ) . POISONING
Sudden of Stroke
Signals A poison is anysubstance thatcancaus ei nj ur y ,
Aswithothersudden illnesses, theprimary sig- illness or deathwhen introduced intothebody
nalsof a strokeor mini-stroke area sudden ( F i g1. 1 - 2 A - D ) ,
c h a n gine h o wth eb o d yi sw o rki nor g feeling. lf yoususpect thata per son is show i ng
s d d ew
T h i su s u a l li yn cl u d esu n e a knessor signals of poisoning, callthePoison C ontr ol
n u m b n eo ssfth efa ce a, rmo r l e g Usually,
. weak- Centerat800-222-1222.1f the person is uncon-
n e s so r nu mb n e o ssccu rso n l o
y none sideofthe scious, ther eis a change intheleveof l c on-
body.In addition, thePerson maY- sciousness or if another life- thr eateni ng
. Havedifficulty talking beingunderstood
or condition is pr esent, call9- 1- 1orthel oc al
w h e nsp e a ki n g . emergency n u m b e r .
; 1 S1 i l ! r * t& l d l t F ) ' i l A i l fi l* t ' ? h *1 - 4 l u r k p l nFc**r t i c i p * x t ' s? 1 1 * r k h * * i t
 lnholotion

Ingesnon

Wz{ . Applyantiseptic ortripleantibiotic ointment.

r#\ . W ashyourhands thor oughly .
,T . lf r ash,
flu- like
signalsorjointp ai nappear s ,
l5r#s. seekmedical attention.
. lf youcannot remove thetickor if itsmouth-
par tsr emain embedded, gettheper s on
medica cal re.
Injetion
CareforScorpion
Stings Bites
andSpider
lf someone hasbeenbitten bya scor pi on,bl ac k
widowspider or br ownr ecluse spi der -
. W ashthewound.
G a r efo r In se ctS ti n g s ' Applya coldpackto thesite.
. Re mo ve th esti n g eSr.cra piet awayfr om the . C a l l 9 - 1o- 1
r t h el o c ael m e r g e nncuym b e r .
s ki nw i thyo u r
fi n g e rn aoirla plastic
car d,or . lf it is available, givethe-person antivenin-
usetweezers. lf youusetweezers, graspthe a medication thatblocks theeffects ofthe
stinger, notthevenomsac. spiderpoisonous
's venom.
. Washthesitewithsoapandwater.
. Co veth r esi tea n dke e pi t cl ean. Carefor SnakeBites
. A p p l ya co l dp a ckto th ea re ato r educe pain lf someone hasbeenbitten bya pitv i per( s uc h
a n dsw e l l i n g . asa rattlesnake, copperhead or cottonmouth)-
. Wa tchth ep e rsofo n rsi g n a ls
of analler gic . Call9- 1- 1 orthelocalemer genc num
y ber .
r ea cti o n . . W ashthewound.
. Kegp theinjur ed ar eastillandlow erthan
Garefor TickBites theheart.
. Witha gloved hand,graspthetickwithfine- lf som eone hasbeenbitten byanel api d
t i p p e dp,o i n te n
do, n e tch enonr
d, asped snake ( such (
asa cor alsnake) 1 1- a) -Fig.
tweezers ascloseto theskinaspossible . C a l9l - 1 - o1 rt h el o c ael m e r g e nncuym b e r .
l o w l (F
a n dp u l sl y i g1. 1 -3 ). . W ashthewound,
o Donottryto burnthetickoff. . Applyanelastic r ollerbandag e.
o D on o ta p p l yp e tro l e uj e
ml lyor nailpolish Foranysnakebite,D0N0T-
to th eti ck. . Applyice.
. P l a ce th eti cki n a se a l a b container
le for . Cutthewound.
a n a l ysi s. . Applysuction.
. Wa shth eb i tea re aw i thso a pandwar m . Applya tour niquet.
water. . Useelectr ic shock.

$ r ; * * * ni i i n n * si 4 $
 suchaspoison ivy,poisonsumac andpoison
.9
oak (Fig.
11-sA-C).
Washclothing exposed to plantoils.Wash
cO
yourhands thor oughly
afterhandl i ng
q exposed clothing.
€ Puta pasteof bakingsodaandwateronthe
.9

o
ar easever al
tim esa dayif a r as horw eep-
= ingsor ehasalr eadybegun to d ev el op.
';
o
Seea healthcareprovider if thecondition
getsworse.
Carefor AnimalBites FILIIN THEBTANKS
. Control bleeding firstif thewoundis bleed-
1. lf youknowa per son
hasa m edi c alc ondi -
ingseriously.
. D on o tcl e a nse ri o uws o u n ds;the you
tion, can givem or especificcar ethani f
wound youdonotknowthecauseof sudden ill-
w i l lb ecl e a n eadt a me d i calfacility.
ness. Them edical
conditions
co ul di nc l ude
C a l l 9 - 1o- 1
r t h el o c ael m e r g e nncuym b ei fr
t h ew o u n di s b l e e d i nseg ri o uslyoryousus-
p ectth ea n i mami l g hht a verabies.
Washminorwounds withsoapandwater.
C o n tro a ln yb l e e d i n g .
A p p l ya ntri p l ea n ti b i o tioci n tm ent
anda
d re ssi n g .
lf a person vomits, position
theperson on
Watchforsignals of infection.
h i so r h e r
Garefor MarineLifeStings lf a person faintsandyoudonotsuspect a
head, neckor backinjur y, positi on
theper -
Fora jellyfishsting-
. So a kth ea re ai nvi n e g a r. sononhisor her
andelevate the
Fora stingray sting-
. l mmo b i l ith a b o u1t 2i n c h e s .
zeea re a .
. S o a kth ea re ai n n o n sca l d ing 4. Fora knowndiabetic emergency, givethe
hotwateruntil per s0n
paingoesaway.
. C l e aann db a n d a gt heew o u n d . lf poisoning wer esuspected yo,uw oul d
givethefollowing careto theperson
Garefor Exposure
to Poisonous
Plants
. Remove exposedclothing
andwash
theexposedareathoroughly
with
soapandwaterassoonas possible
withpoisonous
aftercontact plants,

; ;
@

3 I
- '-
-

$ * I I i r s t A i t j l t f ] n l , q f i fi l* r l h * \ e J * r k p l * * P
* n r t i r : i p a n t\ '4s1 * r k * r : * ! c
HEAT-
ANDCOLD.RELATED
EMERGENCIES
HEAT.RELATED
EMERG
ENCIES Garefor Heat-Related
Emergencies
Heat-related emergen ciesare progressive con- Takethefollowing stepsto careforsomeone
ditions caused byoverexposure to heat.lf rec- suffering from a heat-related emergency:
. Movetheperson to a coolplace.
ognized intheearlystages, heat-related
. Loosen tight clothing.
e m e rg e n cica e snu su a l lbyere ver sed. lf notr ec-
progress . Remove perspiration-soaked clothing.
ognized early, theymay to heatstroke,
. Applycool,wettowelsto theskin.
a life-threatening condition.
. Fantheper son ( Fig.
12- 1) .
Therearethreetypesof heat-related emer-
g e n c i e s. . lf the person is conscious, givesmall
. Heatcramps arepainful muscle spasms that amounts of coolwaterto drink.
u su a l loyccu irnth el e g sa n dabdom en. Heat lf the person refuses water,vomitsor starts
cramps aretheleastsevere oftheheat- to loseconsciousness-
. Sendsomeone to call9- 1- 1orth el oc al
r el a teedme rg e n ci e s.
. Heatexhaustion (earlystage) is anearly emer gency num ber .
. Place the per son onhisor hers i de.
indicator thatthebody's cooling system is
. Continue to cooltheperson byusingiceor
b e co mi nogve rw h e l me of heat
S di g. nals
e x h a u sti ionncl u d e - cold packs on their wrists, ankles, groinand
. Co o lmo , i st,p a l ea, sh e no rflushed skin. neck,andinthearmpits.
. He a d a chnea, u se a . Continue to checkbreathing andsignsof life
d ,i zzi ness.
. Weakness, exhaustion. (coughing or movement in response to res-
. Heavy sweating. cuebr eaths or a pulse) .
. Heatstroke(latestage)is whenthe body's
systems areoverwhelmed byheatandstop COtD.REIATED EMERGENCIES
functioning. Heatstrokeis a life-threatening It doesnothaveto beextremely coldforsome-
condition. Signals of heatexhaustion oneto suffera cold-related emergency, espe-
i ncl u d e - ciallyif theperson is wetor if it iswindy.
. Red,hot,dryskin.
. Ch a n g ei nsth el e veol f co nsciousness. Hypothermia
. Vomiting.
Hypothermia occurswhentheentirebodycools
because itsabilityto keepwarmfails.Theper-
sonwilldieif notgivencare.
SIGNATS OFHYPOTHERMIA
. Shivering, glassy
numbness, stare
. Apathy,weakness, judgment
impaired
. Lossof consciousness

Carefor Hypothermia
. Oentlymovethepersont0 a warmplace,
. Monitorairway,breathing
andcirculation.
. Qiver escue
br eathing
or CPRif needed.
. Remove anywetclothinganddrythe
person.

c le r * e n c i e s| $ 1
N { e n la-n df ; c l d - R e l a t eI m
 Handle theareagently; neverrubthe
affected area.
Warmgentlybysoaking theaffected areain
warmwater(100 o-1050 F)untilnormal color
returns andtheareafeelswarm (Fig. 12-3A).
Loosely bandage theareawithdry,sterile
dr essings ( Fig. 12- 3B) .
lf theperson's fingers ortoesarefrostbitten,
placedry,sterilegauzebetween themto
keepthemsepar ated.
Avoidbreaking anyblisters.
Takeprecautions to prevent hypothermia.
C a l9l - 1 - o1 r t h el o c ael m e r g e nncuym b e r t o
seekem er gency m edical car eass oonas
possible.
. W a rmth ep e rsobnyw ra p p i ng himor herin
blankets or byputting dryclothing onthe
p e rso(p n a ssi ve (Fig.
re w a rmi n g ) 12- 2) .
. lf theperson is alert,givehimor herwarm
I
l i q ui dto
s d ri n kth a td on o tco n tain alcoholor h.
caffeine. pffi ;
. H o tw a te rb o ttl easn dch e mi cal hotpacks ffi
maybeusedwhenfirstwrapped in a towel -"._ffi j

o r bl a n kebte fo re a p p l yi n g . w
tffi 'j --.,
,
o D on o tw a rmth ep e rsoto n oquickly, such ffi F\,
100-105'F ffi
a sb yi mme rsi n hg i mo r h e ri nwar mwater . @ :
R a p iwd a rmi nma g yca u se d anger ous
heartrhythms

Frostbite
*-.ffigt
Frostbite isthefreezing of bodypartsexposed to
t h ec o l d.S e ve ri d
tye p e n dosnth ea irtemper a-
ture,length of exposure andthewind.Frostbite
c a nc a u se th el o sso ffi n g e rs,
h a n ds,
ar m s,
toes,
f e e ta n dl e g s,
S I G N A TOSFF R O S T B I T E
. L a c ko ffe e l i nign a na ffe cteadrea
. Sk inth a ta p p e a rs w a xy,co l dto thetouchor
(fldu sh ew
d i sco l o re dh, i teye
, l l owor blue)
C A R EF ORF R OS T B IT E
. G e th
t ep e rsoonu to fth eco l d .
. Donotattemptto rewarm thefrostbitten
area
if thereis a chance thatit mightrefreezeor if
youarecloseto a medical facility.

f i ; ; i l ! r sr& i d l i l P ffi /Af*r

i l tri h * V tr l*r kpi**r
f*r*{ i*ipar :rW
' s ur ki:**ls