First aid is the immediate care given to someone in an emergency situation, due to an illness or injury before EMS(Emergency Medical Services) arrives and takes over. Most of the time first aid is provided by a bystander (or by the victim) with minimal or no medical equipment. First aid is usually provided for minor illnesses and injuries. However, first aid may also be provided to someone who has a more serious illness or injury, such as a heart attack or severe bleeding.

Important Terms

Fear of being sued has caused reluctance for bystanders to become rescuers in emergency situations. However, initial rescuers are rarely sued and in most emergencies you are not legally required to provide first aid.

Good Samaritan Law – provides protection against lawsuits for persons who are acting in good faith, while providing reasonable first aid. These laws are not a substitute for competent first aid or for staying within the scope of rescuer training. Laws vary from state to state, and it is important to become aware of your state’s guidelines.

Although laws vary, Good Samaritan protection generally applies when the rescuer is:

  • Acting in an emergency situation
  • Acting in good faith, indicating that he or she has good intentions
  • Acting without compensation
  • Not guilty of malicious misconduct or gross negligence toward the victim (intentionally NOT following established medical guidelines)

Duty to Act – requires an individual to provide first aid when they have a legal duty. If a rescuer does not have a legal duty to provide care he or she is not required to provide first aid.

Duty to act may imply in the following situations:

  • When it is a requirement of employment. If you are designated as responsible for providing first aid to meet Occupational Safety and Health Administration (OSHA) requirements and you are called to emergency, you are required to provide first aid. (some examples of occupations that may require a duty to act include, but are not limited to: park rangers, athletic trainers, law enforcement officers, life guards, teachers)
  • When a pre-existing responsibility to a person exists. If you have a pre-existing relationship and are responsible for a person, for example a parent, you must give first aid if they need it (some examples of pre-existing relationships are parent/child, driver/passenger).
Consent
  • Permission from a responsive (alert) person allowing you to provide care.
Implied Consent
  • When a victim is unconscious, it is understood that if the person were responsive (alert), he or she would request and allow you to provide care.
Abandonment
  • When a rescuer initiates care and fails to continue to provide care until EMS or a second rescuer takes over.
Negligence
  • When you have a duty to respond to an emergency situation and you fail to provide care or give inappropriate care which causes injury or harm.
Universal Precautions
  • Wearing gloves, gowns, masks, and other protective devices every time you provide care in situations where you may come into contact with bodily fluids.
Clinical Death
  • When a victim’s breathing and heartbeat stops. There is a high likelihood that victims who are clinically dead for less than 6 minutes can be revived with little to no cellular damage.
Biological Death
  • When a victim’s breathing and heartbeat stops. Persons who are clinically dead for 10 minutes or more may have irreversible damage to brain cells and tissues. Reviving a victim is not likely, however it is not impossible.

Rescuer Concerns

Safety
  • Rescuers should never enter unsafe situations. If your safety or that of the victim’s is at risk, do not attempt to provide care. Instead call EMS and wait for EMS support to arrive.
Infectious Disease
  • Using personal protective devices, such as gloves, masks, gowns, etc… can reduce your exposure to infectious diseases.
Lawsuits
  • States have Good Samaritan laws in place to provide protection for rescuers who are acting in good faith, in situations where the rescuer does not have a legal duty to provide care.
Hurting a Victim
  • Victims who are clinically dead are helped when provided care and not often made worse with rescue efforts.
Inability to Save Victim
  • Rescuers should focus on providing care to the best of their ability. Basic life support efforts can improve a victim’s chance of survival. Rescuers who have provided care in traumatic situations may feel overwhelming emotions. If a rescuer continues to experience depressed like symptoms it is important to seek support from an outside resource.

Personal Protective Equipment (PPE)

Personal protective equipment should be used when available, prior to providing care. This equipment is designed to minimize exposure to infectious diseases and bodily fluids.

Gloves
  • Always use medical exam gloves when providing care
  • Check for rips, tears or damage before providing care
  • Remove any jewelry that may damage or cause tears
  • If you have a latex allergy use alternative vinyl or nitrile gloves
  • Remove gloves using skin to skin and glove to glove method
    • Using gloved hand, pinch the wrist of the other gloved hand
    • Pull the glove off while turning inside out, place in palm of gloved hand
    • Using bare hand place fingers inside wrist of gloved hand and remove inside out, collecting the gloves inside each other
    • Dispose of gloves in an appropriate container
Rescue mask/Face shield
  • Always use when providing rescue ventilations
  • Mask or shield should have a one way valve to prevent exposure to bodily fluids
  • Dispose of mask/shield in an appropriate container

Chain of Survival

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The Chain of Survival is a common way of describing the order in which rescuers should provide care for a victim of cardiac arrest. Early action can improve the chance of a victim’s survival.

Link One: Early Access
  • Rescuer recognizes early warning signs and immediately calls EMS to activate EMS (emergency medical services) to provide early access to care.
Link Two: Early CPR
  • Rescuer immediately begins CPR cycle to continue minimal supply of blood to the victim’s heart and brain until defibrillator and EMS personnel take over.
Link Three: Early Defibrillation
  • Rescuer utilizes AED (automated external defibrillator) to administer a shock to the victim which may restore the heartbeat in some instances.
Link Four: Early Advanced Care
  • EMS arrives and provides advanced cardiac life support care to victim of sudden cardiac arrest. In addition, EMS may provide IV fluids, medications, and use advanced airway devices.

Action at an Emergency

In an emergency situation, the bystander is a vital link between the victim and Emergency Medical Services (EMS). When entering the scene of an emergency situation, it is important to recognize the severity of the emergency before deciding how to respond.

Assess the Scene

Always remember to check the scene for safety hazards BEFORE providing care, it is important to ensure if you and the victim(s) are in a safe location, free of imminent danger or hazards.

  • Determine
    • if it is safe to help
    • number of victims
    • if you will need additional assistance from EMS
    • what personal protective devices are readily available to you
  • Safety
    • If the area is unsafe for the victim or rescuer, move the victim to a safe location, if can be done safely
    • Do not put you or the victim’s safety at risk
    • If you cannot safely provide care, do not become another victim, call EMS and wait for EMS to arrive
Activate EMS
  • For serious situations, always call EMS
  • Provide vital information to EMS dispatcher
    • Your name and number
    • Location of emergency
    • Information about the type of emergency
    • Number of victims
    • Victim(s) condition
    • What care is being provided at the scene
Assess the Victim
  • Check the victim for responsiveness
  • Tap on the shoulder and shout, “Are you okay?”
  • Ask the victim if you he or she would like you to provide care
  • If the victim is facedown and unresponsive, turn the victim over
  • Check the victim for breathing
    • If victim is not breathing – begin CPR
    • If victim is breathing – check the victim and provide care
  • Check the victim for obvious signs of injury, such as bleeding, broken bones, burns, or bites
  • Look for medical information jewelry to determine if the victim has a serious medical condition
  • Place the victim in recovery position (on side)
    • If the victim has difficulty breathing because of vomiting, or other secretions
    • you have to leave an unresponsive victim to get help
  • If the victim shows signs of shock, have the victim lie flat on back
  • If the victim does not show signs of trauma or injury, raise the feet about 6-12 inches.
    • Do not raise the feet if it causes the victim any pain
Provide Care
  • Decide to provide care
  • Determine what type of care is needed
  • Begin care immediately – early care is critical for a victim’s survival

Victim Assessment

When providing care to a victim it is important to identify and correct any condition that may not be immediately life threatening, but may have the potential to become life threatening should they not be corrected.

SAMPLE

Gather information about victim using the SAMPLE history method. Ask victim about the following information

  • Signs and symptoms
  • Allergies
  • Medications
  • Past medical history
  • Last meal eaten
  • Events leading to the injury or illness

Medical information tags may identify allergies, medication, or medical condition

DOTS

Use the DOTS method to check the victim head to toe for the following conditions

  • Deformity
  • Open wounds
  • Tenderness
  • Swelling
Head to Toe exam
  • Head – look for blood, check eyes, check mouth for loose teeth or blood, check the nose and ears for fluid or blood, look for bruising of the eyes or behind the ears
  • Neck – look for bleeding, distention of the jugular vein, open wounds, or tracheal deviation
  • Chest –look for blood, broken ribs, open wounds, accessory muscle breathing
  • Abdomen –look for bleeding, abdominal wounds, tenderness, bruising
  • Legs –look for bleeding, bruising, open wounds, broken bones, deformities
  • Pelvis –look for bleeding and instability
  • Arms –look for bleeding, bruising, open wounds, broken bones, deformities
While you are waiting for EMS to arrive
  • Recheck the victim’s condition using ABC assessment:
    • Airway – use head tilt-chin lift method
    • Breathing – look, listen and feel for breathing
    • Circulation – check for severe bleeding
  • Treat for shock
    • Help victim lie on back
    • Keep covered and warm
    • Do not give anything to eat or drink
  • Remain with victim and record any changes in the victim’s condition
  • Report your findings and care to EMS when they arrive
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute