AmericanRedCross RespondingToEmergencies InstructorsManual 031612

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Responding to Emergencies: Comprehensive First Aid/CPR/AED

INSTRUCTORS MANUAL
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This Responding to Emergencies: Comprehensive First Aid/CPR/AED Instructors Manual is part of the American Red Cross Responding to Emergencies: Comprehensive First Aid/ CPR/AED course. Visit redcross.org to learn more about this course. The emergency care procedures outlined in this book reflect the standard of knowledge and accepted emergency practices in the United States at the time this book was published. It is the readers responsibility to stay informed of changes in emergency care procedures. The enclosed materials, including all content, graphics, images and logos, are copyrighted by and the exclusive property of the American National Red Cross (Red Cross). Unless otherwise indicated in writing by the Red Cross, the Red Cross grants you (recipient) the limited right to receive and use the printed materials, subject to the following restrictions:

The recipient is prohibited from reproducing the materials for any reason. The recipient is prohibited from creating electronic versions of the materials. The recipient is prohibited from revising, altering, adapting or modifying the materials. The recipient is prohibited from creating any derivative works incorporating, in part or in whole, the content of the materials.
All rights not expressly granted herein are reserved by the Red Cross. The Red Cross does not permit its materials to be reproduced or published without advanced written permission from the Red Cross. To request permission to reproduce or publish Red Cross materials, please submit your written request to The American National Red Cross.
2012 American National Red Cross. ALL RIGHTS RESERVED. The Red Cross emblem, American Red Cross and the American Red Cross logo are trademarks of The American National Red Cross and protected by various national statutes.
Published by Krames StayWell Strategic Partnerships Division Printed in the United States of America ISBN: 978-1-58480-555-7
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ACKNOWLEDGMENTS
This manual is dedicated to the thousands of employees and volunteers of the American Red Cross who contribute their time and talent to supporting and teaching lifesaving skills worldwide and to the thousands of course participants and other readers who have decided to be prepared to take action when an emergency strikes. Many individuals shared in the development and revision process in various supportive, technical and creative ways. The American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED Instructors Manual was developed through the dedication of both employees and volunteers. Their commitment to excellence made this manual possible. American Red Cross Scientific Advisory Council This instructors manual reflects the 2010 Consensus on Science for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC) and the Guidelines 2010 for First Aid. These treatment recommendations and related training guidelines have been reviewed by the American Red Cross Scientific Advisory Council. The American Red Cross Scientific Advisory Council is a panel of nationally recognized experts in the fields of emergency medicine, sports medicine, emergency medical services (EMS), emergency preparedness, disaster mobilization, and other public health and safety fields.
A special thanks to the following members of the American Red Cross Scientic Advisory Council for their guidance and review:
David Markenson, MD, FAAP, EMT-P
Chair, American Red Cross Scientific Advisory Council Chief, Pediatric Emergency Medicine Maria Fareri Childrens Hospital Westchester Medical Center Valhalla, New York
David C. Berry, PhD, ATC, EMT-B

Member, American Red Cross Scientific Advisory Council Associate Professor of Kinesiology and Athletic Training Education Program Director Saginaw Valley State University University Center, Michigan
Andrew MacPherson, MD, CCFP-EM, FCFP

Chair, First Aid Subcouncil, American Red Cross Scientific Advisory Council Canadian Red Cross National Medical Advisory Committee Department of Emergency Medicine Victoria, British Columbia, Canada
Jonathan L. Epstein, MEMS, NREMT-P

Vice Chair, American Red Cross Scientific Advisory Council Northeast EMS, Inc. Wakefield, Massachusetts
Jeffrey L. Pellegrino, Ph.D.

Member, American Red Cross Scientific Advisory Council Faculty Professional Development Center Kent State University Kent, Ohio
Peter Wernicki, MD
Aquatics Chair, American Red Cross Scientific Advisory Council Sports Medicine Orthopedic Surgeon International Lifesaving Federation Medical Committee Past Chair U.S. Lifesaving Association Medical Advisor Vero Beach, Florida
Andrew MacPherson, MD, CCFP-EM, FCFP

Canadian Red Cross National Medical Advisory Committee Chair, First Aid Subcouncil, American Red Cross Scientific Advisory Council Department of Emergency Medicine, Victoria, British Columbia, Canada
Joseph W. Rossano, MD, FACC, FAAP

Member, American Red Cross Scientific Advisory Council Medical Director, Heart Transplantation Attending Physician Cardiac Intensive Care Unit Assistant Professor of Pediatrics Childrens Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
Acknowledgments
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The American Red Cross team for this edition included:

Jennifer Deibert
Director of First Aid/CPR/AED for the Professional Rescuer
Don Lauritzen
Officer Preparedness and Health and Safety Services Communications
John Thompson
Senior Associate Division Support
Lisa Silverman
Director of First Aid/CPR/AED for the Lay Responder
Michelle Jantz Paula Moore

Senior Marketing Consultant Manager Operations Division Support
Gina Gunn
Channel Manager First Aid/CPR/AED
Denise Gonzlez Hensal

Business Analyst Information Technology
Guidance and support were provided by the following individuals:

Jack McMaster
President Preparedness and Health and Safety Services
Stephen Glockenmeier
Vice President Preparedness and Health and Safety Services
The StayWell team for this edition included:

Nancy Monahan
President
David Cane
Managing Editor
Carolyn Lemanski
Senior National Account Executive
Paula Batt
Vice President Sales and Business Development
Danielle DiPalma
Editorial Director
Kate Plourde
Marketing Director
Jennifer Surich Reed Klanderud

Vice President Strategic Services Executive Editor
Dana Dinerman
Senior Content Manager
Ellen Beal
Executive Editorial Director
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TABLE OF CONTENTS
SECTION
ADMINISTRATION
Health Precautions for Course Participants ______________________ 9 Participants with Disabilities and Special Health Considerations ________ 9 Course Modications for Different Settings _______________________10 Chapter 4 Criteria for Assessing Participants ______11 Criteria for Course Completion and Certication ________________________11 Evaluating Skills ________________________11 Scenarios______________________________11 Written Exams __________________________12 Criteria for Grading Participants __________13 Reporting Procedures ___________________13 Participant Course Evaluation ____________13 Awarding Certicates ___________________13 Continuing Education Units for Professionals __________________________14
Chapter 1 Introduction ____________________________ 2 Purpose of the Course ___________________ 2 Course Participants ______________________ 2 Instructors Responsibilities_______________ 2 American Red Cross Resources___________ 3 Chapter 2 Course Design__________________________ 4 Course Content _________________________ 4 Participant Materials _____________________ 4 Instructor Materials ______________________ 5 Additional Resources for Instructors and Participants _________________________ 7 Instructional Design Elements in the Responding to Emergencies: Comprehensive First Aid/CPR/AED Course _______________ 7 Chapter 3 Setting Up and Running This Course _____ 8 Class Size ______________________________ 8 Course Length __________________________ 8 Classroom Space________________________ 8 Class Safety ____________________________ 8
SECTION
TEACHING TOOLS
PART THREE
Lesson 9 Cardiac Emergencies ___________________60
PART ONE
Course Outline ____________________________________16 Lesson 1 Lesson 2 Lesson 3 Lesson 4 Lesson 5 Introduction ____________________________18 Healthy Lifestyles (Optional) _____________21 If Not You Who? _____________________24 Taking Action __________________________30 Before Giving Care _____________________37
Lesson 10 CPRAdult ____________________________65 Lesson 11 CPRChild ____________________________70 Lesson 12 CPRInfant ____________________________75 Lesson 13 AEDAdult ____________________________80 Lesson 14 Adult AED Skill Practice and Scenarios__________________________86 Lesson 15 AEDChild and Infant __________________94 Lesson 16 Child AED Skill Practice and Scenarios__________________________99 Lesson 17 Breathing Emergencies ________________108
PART TWO
Lesson 6 Lesson 7 Lesson 8 The Human Body _______________________44 Checking an Unconscious Person ________48 Checking a Conscious Person ___________55
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Lesson 18 Conscious ChokingAdult and Child ____116 Lesson 19 Conscious ChokingInfant _____________121 Lesson 20 Unconscious ChokingAdult and Child ___125 Lesson 21 Unconscious ChokingInfant ___________130 Lesson 22 Bleeding______________________________135 Lesson 23 Internal Bleeding/Shock _______________141 Lesson 24 Putting It All Together I (Introduction, Assessment and Life-Threatening Emergencies) _________________________145 Lesson 33 Sudden Illnesses IV/Substance Abuse and Misuse ___________________________221 Lesson 34 Heat-Related Illnesses and Cold-Related Emergencies _____________229 Lesson 35 Putting It All Together II/Injuries and Sudden Illness ____________________239
PART SIX
Lesson 36 Water-Related Emergencies ____________246 Lesson 37 Pediatric, Older Adult and Special Situations ____________________________253 Lesson 38 Emergency Childbirth (Optional) ________265 Lesson 39 Disaster, Remote and Wilderness Emergencies I ________________________272 Lesson 40 Disaster, Remote and Wilderness Emergencies II _______________________279 Lesson 41 Putting It All Together III/Course Review _______________________________286
PART FOUR
Lesson 25 Soft Tissue Injuries I ___________________151 Lesson 26 Soft Tissue Injuries II/Musculoskeletal Injuries I ______________________________159 Lesson 27 Musculoskeletal Injuries II and Splinting __________________________166 Lesson 28 Injuries to the Head, Neck and Spine ____178 Lesson 29 Injuries to the Chest, Abdomen and Pelvis ____________________________188
Lesson 42 Field Exercise (Optional) _______________292 Lesson 43 Final Written Exam I: Before Giving Care __________________________294 Lesson 44 Final Written Exam II: CPR/AED _________296 Lesson 45 Final Written Exam III: Responding to Emergencies: First Aid _________________298
PART FIVE
Lesson 30 Sudden Illnesses I _____________________194 Lesson 31 Sudden Illnesses II/Poisoning __________202 Lesson 32 Sudden Illnesses III/Bites and Stings ____________________________211
SECTION Appendix A: Appendix B:
APPENDICES
Appendix F: AED Resource Information ___________322 Appendix G: Video Segments for the Responding to Emergencies course ______________328 Appendix H: Frequently Asked Questions About First Aid, CPR and AED ________330 Written Exams, Answer Sheets and Answer Keys ____________________342
Scenario Worksheets ________________302 Health Precautions and Guidelines During Training ___________310 Master Checklist of Course Materials, Equipment and Supplies ____312 Teaching Strategies _________________314 Participant Progress Log _____________320
Appendix C:
Appendix D: Appendix E:
Appendix I:
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Administration
Administration
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INTRODUCTION
This instructors manual is intended to serve as a resource for instructors of the American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED course. The information and teaching strategies it provides will help you teach the course. You should be familiar with the material in both the American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED textbook (Stock No. 656138) and this instructors manual before you teach the course.
Purpose of the Course

The purpose of the American Red Cross Responding to Emergencies course is to help participants recognize and respond appropriately to cardiac, breathing and first aid emergencies. The course teaches skills that participants need to know to give immediate care to a suddenly injured or ill person until more advanced medical personnel arrive and take over. The care steps outlined within this product are consistent with the Guidelines 2010 for First Aid and the 2010 Consensus on Science for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Course Participants
The majority of the participants will be taking this course in an academic environmenthigh school, college or university. They may be taking the course to fulfill current or future employment requirements. There are no prerequisites, such as previous training in first aid, for enrollment in the course.
Instructors Responsibilities
It is your responsibility as an instructor to see that participants meet the learning objectives listed at the beginning of each chapter in the participants textbook and at the beginning of each lesson in this instructors manual. Your responsibilities when teaching an American Red Cross Responding to Emergencies course include:
they have concerns about their physical ability to do so. The classroom and all practice areas are free of hazards.

Being familiar with and knowing how to effectively use course materials and training equipment. Planning, coordinating and managing training, including advising the Red Cross in advance of any classes you are scheduled to teach. Informing participants about knowledge and skills evaluation procedures and course completion requirements. Creating a nonthreatening environment that is conducive to achieving the learning objectives. Preparing participants to meet the course objectives. Providing participants an opportunity to evaluate the course.
Providing for the health and safety of participants by always ensuring that Manikins have been properly cleaned according to Recommendations on Manikin Decontamination, which is available on Instructors Corner. Other course equipment (medical and first aid supplies) is clean and in good working order. Participants are aware of health precautions and guidelines concerning the transmission of infectious diseases. All participants have the physical ability to perform the skills and know to consult you if
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Adapting your teaching approach to match the experience and abilities of the participants, identifying participants who are having difficulty and developing effective strategies to help them meet course objectives. Supervising participants while they are practicing course skills and providing timely, positive and corrective feedback as they learn. Evaluating participants as they perform skills, focusing on critical performance steps as described in the skill charts. Administering and scoring written exam(s). Conducting courses in a manner consistent with course design. Issuing course completion certificates. Submitting completed course records and reports to the Red Cross within 10 working days from course completion. Being familiar with and informing participants of other Red Cross courses and programs.
Being prepared to answer participants questions or knowing where to find the answers. Providing a positive example by being neat in appearance and not practicing unhealthy behaviors, such as smoking, while conducting American Red Cross courses. Identifying potential instructor candidates and referring them to the appropriate Red Cross representatives. Abiding by the obligations in the Instructor Agreement and Code of Conduct and, if applicable, the Authorized Provider or Licensed Training Provider Agreement. Representing the Red Cross in a positive manner. Encourage participants to visit redcross.org to find out about other opportunities to support the Red Cross, including volunteering for Disaster Services or donating blood.
American Red Cross Resources

Keep updated on the latest instructor information by visiting Instructors Corner (instructorscorner.org). This site provides access to digital program materials and video, frequently asked questions, program updates and course-related forms. The American Red Cross Learning Center provides online access to manage instructor and course records, and print certificates. If you need further information or support for your program, contact the Training Support Center at 1-800-RED CROSS or support@redcrosstraining.org.
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Introduction
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COURSE DESIGN
Course Content
The technical content within the Responding to Emergencies course reflects the most current consensus on scientific recommendations. The course content includes the knowledge and skills necessary for participants to safely identify and give appropriate care, regardless of the type of emergency. The course stresses the basic steps to follow in any emergency, beginning with the most important stepthe decision to actand helps participants confront their fears of getting involved and giving care. The course explains the emergency medical services (EMS) system, emphasizes the need for rapid medical assistance in an emergency and provides instruction on appropriate care for a variety of injuries and sudden illnesses that lay responders may encounter in their workplaces, schools, communities and homes.
Participant Materials
American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED Textbook
The textbook has been designed to simplify learning and understanding of the material. Features of the textbook include:

First Aid and CPR/AED Refreshers

First aid, CPR and AED knowledge and skills begin to decline within as little as 3 months after training. That is why refreshersa series of short, online learning exercises and quizzesare available as part of American Red Cross First Aid/CPR/AED programs. Refreshers help support skill retention by giving participants opportunities to test and reaffirm first aid, CPR and AED knowledge and practice skills learned in class. The goal of the refresher program is to keep the skills and knowledge learned in class fresh in participants minds. Although participation in the refresher program is voluntary, all participants are strongly encouraged to complete the refreshers every 3 months. Advise students to go to www.redcrossrefresher.com after completion of the course and select refreshers for workplaces, schools and individuals.
Learn and Respond scenarios. Learning objectives. Key terms. Study questions. Ready to Respond? questions. What If? boxes. Sidebars. Smart Moves Prevention Boxes. Tables. Skill sheets. Glossary.
The textbook is required for the course and is available in both print and digital formats.
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Instructor Materials
American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED Instructors Manual
The instructors manual contains all the information needed for planning, preparing and conducting courses. Although the lesson plans are essential (and required) during class, other information included in the instructors manual is more useful for planning and preparation. To account for this range of uses, the instructors manual is available in two formats: a full print version, which is available for purchase, or a free electronic version, which can be printed out on-demand from Instructors Corner. For those who wish to use the free electronic version, it is advised that they print out only Section B (the lesson plans) but not Sections A and C, which can be viewed online at any time. The lesson plans have been streamlined for easy printing. This instructors manual consists of the following sections:

Section C: Appendices. The appendices at the end of this instructors manual contain the detailed information essential for effectively conducting a course, including how to carry out skill sessions and activities, health and safety precautions, and a list of the video segments used during the course. The following appendices are located in Section C: Appendix A: Scenario Worksheets Appendix B: Health Precautions and Guidelines During Training Appendix C: Master Checklist of Course Materials, Equipment and Supplies Appendix D: Teaching Strategies Appendix E: Participant Progress Log Appendix F: AED Resource Information Appendix G: Video Segments for the Responding to Emergencies Course Appendix H: Frequently Asked Questions About First Aid, CPR and AED Appendix I: Written Exams, Answer Sheets and Answer Keys
Section A: Administration. This section explains the purpose of the course and provides instructors with necessary administrative information as well as overviews of course materials, course content and delivery options. Section B: Teaching Tools. This section contains the lesson plans for the course. Review the relevant lessons before conducting a course so that you are comfortable with the unique structure, instructional approach and content of each lesson. Because of the streamlined approach used to accommodate those who wish to use the free electronic version, the lesson plans contain only the information necessary to conduct the course. Additional information on conducting specific course activities is available on Instructors Corner. Instructors should be familiar with the content of the following lesson components: Guidance for the Instructor Lesson Objectives Outline for the Instructor Materials, Equipment and Supplies Activities Skill Sessions (not included in all lessons) Visual Aid Lesson Wrap-Up
American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED Course Presentation
Another resource for instructors is the Responding to Emergencies course presentation. Similar to a PowerPoint presentation, the course presentation is an in-class visual aid that is projected onto a screen or viewing area. Instructors click through the presentation slides as they progress through the lessons. The course presentation is designed to include all the visual information needed to conduct the Responding to Emergencies course. The course presentation includes photos, video segments and lecture points. Before conducting the course, become familiar with the presentation software and test the system used for its display. Although printed reference materials are not necessary when using the course presentation, it is recommended that you have back-up copies of the presentation in case technical difficulties occur.
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Course Presentation System Requirements:

Adobe Reader 9 Flash Player 8 or 9 for Windows and Mac Flash Player 9 for Linux and Solaris
NOTE: The standardized final written exam(s) for this course can be found in Appendix I and must be passed to receive Red Cross certification.
Instructors Corner
As an instructor, it is very important that you register on Instructors Corner at redcross.org/instructorscorner and visit the site regularly for program information and updates. Once you have completed the brief registration process, you will have free access to many important resources for instructors. Responding to Emergencies course materials on Instructors Corner include:

Equipment Requirements:

Laptop/desktop computer Power source Projector (including any connection cables) Projection screen/area Computer speakers (or other source for sound)
The presentation is available to download from Instructors Corner. The presentation is saved as a PDF. To view the presentation, save the file to your computer and double click on the PDF icon to open it. Additional directions for using the course presentation are available on Instructors Corner.
Course Fact Sheet Sample Letter to Responding to Emergencies course participants Responding to Emergencies: Comprehensive First Aid/CPR/AED Course Presentation Responding to Emergencies: Comprehensive First Aid/CPR/AED Videos Responding to Emergencies: Comprehensive First Aid/CPR/AED Textbook Responding to Emergencies: Comprehensive First Aid/CPR/AED Instructors Manual Responding to Emergencies: Comprehensive First Aid/CPR/AED Test Generator Participant Progress Log Healthy Lifestyles Awareness Inventory Behavior Modification Contract
American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD

The American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD is designed specifically for use during the course. Instructors are required to use the segments on this DVD or included in the course presentation, or streaming from Instructors Corner as they contain model demonstrations that combine real-life scenarios with studio-based skill segments to help ensure that lesson objectives are met. The course may not be conducted if the video or course presentation is not available. For your convenience, Appendix G: Video Segments for the Responding to Emergencies Course, contains a list of the video segments and running times.
Additional resources on Instructors Corner:
Skill Posters
Skills posters for CPR, choking, splinting and checking an injured or ill adult, child and infant have been developed to use in class. When using posters, place them in a location where all participants can see them. For larger classes or larger classroom spaces, multiple posters should be used. Posters are available for purchase on Instructors Corner.

Americans with Disabilities Act (ADA) Accommodations Resource Guide for Conducting and Administering Health and Safety Courses Administrative Terms and Procedures Administrative policies and forms, including the Course Record and Course Record Addendum Recommendations on Manikin Decontamination Participant Course Evaluation Form or access to other available Red Cross surveys Skills posters for CPR, choking, splinting and checking an injured or ill adult, child and infant Information about other Red Cross training and education programs Frequently asked questions and expert answers to your technical questions
Test Generator
A test generator with a test bank of hundreds of questions, broken down by chapter, is available for instructors to create quizzes and tests. It is available on Instructors Corner.
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Instructor News featuring upcoming webcasts, conference dates, program announcements and Red Cross news Link to the American Red Cross Learning Center website
Links to redcrossstore.org and shopstaywell.com for training supplies and Red Cross retail products Links and contact information for the American Red Cross Training Support Center
Additional Resources for Instructors and Participants

Training Equipment and Red Cross Retail Products
Course supplies and equipment, such as CPR breathing barriers, first aid kits and a wide range of Red Cross retail products, are available through the Red Cross store at redcrossstore.org.

Lifeguarding. Swimming and Water Safety. Emergency Medical Response. Family Caregiving. Nurse Assistant Training. CPR/AED for Professional Rescuers and Health Care Providers. Wilderness and Remote First Aid.
Additional Red Cross Courses

A wide range of additional training opportunities in safety and preparedness are offered through the Red Cross. Additional Red Cross courses include:
Refer participants to redcross.org for more information about scheduled courses in their community.
Instructional Design Elements in the Responding to Emergencies: Comprehensive First Aid/CPR/AED Course
To make the course more engaging for the instructor and participants, a variety of interactive exercises are integrated into the lessons along with video-based scenarios and skill demonstrations, skill sessions and traditional lectures. For detailed explanations of each lesson component and additional instructional tools, refer to Appendix D: Teaching Strategies. The activities included in the lessons, such as guided discussions and small-group activities, are designed to correspond with the lesson objectives and reinforce essential information that participants need to know. The lecture points included in the courses represent the fundamental concepts that instructors need to convey to meet the associated learning objectives. They are designed to be read as is or used as a guide, to allow instructors to deliver the lecture material more naturally. Most skill sessions are conducted in one of two ways. Some skills are learned via the practicewhile-you-watch instructional method (e.g., CPR), whereas other skills are learned via the watch-thenpractice instructional method. During skill sessions, participants may use the skill sheets in the participants textbook or view the appropriate course presentation slides as a guide. In addition, the Skill Posters can be used. Skill charts and skill assessment tools are located in the instructors manual at the end of lessons that include skill sessions.
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SETTING UP AND RUNNING THIS COURSE

This chapter explains how to organize the American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED course.
Class Size
The course outline and lesson plans have been developed for a class of approximately 20 participants. If your class is larger, you probably will need to allow more time or have co-instructors or instructor aides help you. The amount of available equipment and assistance from additional instructors may limit class size. Personal supervision is necessary to ensure effective practice and the safety of participants. If the class is too large, you may not be able to provide proper supervision or complete class activities in the allotted time. It is strongly recommended that you have additional instructors help during practice sessions.
Course Length
The Responding to Emergencies course is designed to be taught in approximately 30 hours. The times listed are approximate and based on a class size of about 20 participants with the recommended amount of equipment available for each lesson. Time will have to be added if any of the optional lessons or modules are taught. You must carefully consider the issues of time when planning each class session. The lesson plans in this instructors manual should be followed as closely as possible, but facility constraints, specific instructorto-participant ratios, equipment-to-participant ratios, as well as participant needs, such as breaks, may increase course length. Other factors that may influence lesson planning include:

Classroom availability and layout. Equipment availability. Number of participants. Skill level of participants. Instructor experience. Number of instructors.
Classroom Space
The lessons described in this instructors manual require classroom space suitable for lecture, class discussions, small group activities, video presentations and skill practice sessions. The classroom should provide a safe, comfortable and appropriate learning environment. The room should be well lit and well ventilated and have a comfortable temperature. If the practice area is not carpeted, provide some knee protection, such as folded blankets or mats, for use by participants or allow them to bring their own padding materials.
Class Safety
When teaching the Responding to Emergencies course, it is important for you to make the teaching environment as safe as possible. Participants who feel they are at risk for injury or illness may become distracted. These same feelings may also affect your
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ability to teach. There are several steps you can take to help increase class safety:
Instructor Preparation: Consider possible hazards and manage safety concerns before
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a course starts. Often, you can foresee hazards and take steps to eliminate or control them long before participants arrive.
Assisting Instructors and Co-Instructors: Assisting instructors and co-instructors can help decrease risks by giving more supervision and reducing the instructor-to-participant ratio. They also increase participation and learning by providing more one-on-one attention to participants. When using co-instructors, assisting instructors or instructor aides, clearly define their roles and responsibilities. Doing so will help eliminate confusion and lapses in supervision. Remember that you are ultimately responsible for your participants safety. To determine your staffing needs, consider the different ages and the individual abilities of participants in the course. If your course has a large number of participants, you will need additional help. Instructor Aides: Individuals who express an interest in becoming an instructor but do not, for example, meet the minimum age, can participate
in the course experience as an instructor aide. Instructor aides must always be under the direct supervision of an instructor and should never be left alone to supervise course participants. Instructor aides may not evaluate or certify participants skill performance. An instructor aide must possess a basic-level certificate(s) in the applicable program or course for which he or she wishes to assist. A First Aid/CPR/AED instructor or instructor trainer can train an instructor aide candidate. Contact the Red Cross to get further information about instructor aide training. In general, duties and responsibilities of instructor aides include: Handling registration and record keeping. Setting up classrooms and handing out supplies. Assisting with equipment (e.g., setup, cleaning and distribution of materials). Helping participants with skill practice or small group activities.
Health Precautions for Course Participants

As an instructor, one of your responsibilities is to protect participants from health risks. The materials and procedures for teaching this course are designed to:

Limit the risk of disease transmission. Limit the risk of one participant injuring another when practicing with a partner. Limit the risk that the activity involved in skill practice could cause injury or sudden illness.
When possible, prospective participants should be provided information about health requirements and safety before enrolling in the course. The Sample Letter to Responding to Emergencies: Comprehensive First Aid/CPR/AED Course Participants on Instructors Corner is one way to communicate that information. Ask participants to talk with you before any practice session if they doubt they can participate in the activity.
People with certain health conditions may be hesitant to take part in the practice sessions. These could include a history of heart attack or other heart conditions or respiratory problems. Suggest that these participants check with their health care provider before participating in practice sessions involving physical activity. Inform participants who take the course, but cannot demonstrate the skills taught in the practice sessions, that they cannot receive an American Red Cross course completion certificate. Encourage them, however, to participate to whatever extent possible. The Red Cross advocates that, whenever possible, the instructor adjust participants activity levels as necessary to facilitate learning and help participants meet course objectives.
Participants with Disabilities and Special Health Considerations

People with disabilities and other conditions may be able to perform first aid, CPR and AED skills. Some skills may need to be modified, but the result is the same. Instructors should focus on the critical components of a skill that are needed to successfully meet the objective.
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Detailed guidance on these topics is included in Health Precautions and Guidelines During Training (Appendix B) and the Americans with Disabilities Act (ADA) Accommodations Resource Guide for Conducting and Administering Health and Safety Courses, available on Instructors Corner (redcross.org/instructorscorner).
Course Modications for Different Settings

The Responding to Emergencies course can be customized to meet participants specific needs. It can be offered, for example, as a certification course to meet a regulatory requirement or as an employee benefit program. Schools may integrate training into the curriculum. Some course modification options are built into the course. For example, Lesson 2: Healthy Lifestyles involves having participants complete a Healthy Lifestyles Awareness Inventory for those who want to have this additional information included in the course. Previous first aid or CPR/AED training. Job responsibilities. Educational background. English as a second language.
What site-specific information is known? This includes: The type and frequency of past incidents of injury or sudden illness in the workplace. Established emergency procedures. (Is there a written emergency action plan?) The type and location of first aid supplies at the site. State or local regulations requiring written assessments.
Training in the Workplace

Training to Meet a Workplace Certification Requirement The course is designed to meet the training requirements of various occupational, office or industrial settings. When offering the course to meet certification requirements, adapting the training does not mean that you can add to, delete or change the content. To modify the course for a workplace with certification needs, an instructor should meet with the workplace safety representative to discuss the needs before scheduling a course. A Red Cross representative should convey this information to you so that you can adequately prepare to deliver the course material. As an instructor, you should ask these questions:

Training as an Employee Benefit In some cases, first aid training is offered as an employee benefit rather than for certification or to meet other regulations. Under such circumstances, if the employer does not require or want certification, it is possible to customize the course by presenting only those lessons or topics that meet the employers specific needs. These can be taught as stand-alone lessons, for example, during a lunch hour. Before training begins, the instructor must ensure that the employer understands that although the information to be conveyed is relevant and important, this type of training is not comprehensive and will not result in Red Cross certification for employees.
Why is the workplace customer offering this training? What is the background of course participants? This includes:
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CRITERIA FOR ASSESSING PARTICIPANTS

Criteria for Course Completion and Certication
Red Cross certification means that on a particular date an instructor verified that a participant demonstrated competency in all required skills taught in the course. Competency is defined as being able to demonstrate correct decision-making, sequence care steps properly, and proficiently complete all required skills without any coaching or assistance. To complete the course successfully, the participant must:

Attend all class sessions. Participate in all course activities, including scenarios. Demonstrate competency in all required skills. Pass the final written exam with a minimum grade of 80 percent.
Evaluating Skills
In the Responding to Emergencies course, skills are evaluated during skill sessions within the lessons. As an instructor, your goal is to help participants achieve the performance criteria for each skill. The skill charts and skill assessment tools are the primary tools that will assist your evaluation of participants skills. Before conducting a course, become familiar with the skill charts and skill assessment tools (found at the end of the lesson in which the skill is practiced). The skill charts contain the required steps of a skill in numerical order. The skill assessment tools provide assessment criteria for proficient and not proficient performance of the critical components of a skill that are necessary to meet the objective. Skill assessment tools include specific depths, ranges, rates, intervals, times and other quantifiable elements by which you assess skill performance. The skill assessment tools are designed to help you decide whether a participant has met the objective. During skill sessions, you should check off a skill as completed on the participant progress log once participants demonstrate proficiency in it. It is your responsibility as the instructor to observe participants skill performances to determine whether they are performing the skill correctly with respect to sequence, timing and duration, and whether their techniques meet the established skill proficiency criteria. To complete the course requirements and receive a completion certificate, the participant must be able to complete all required skills proficiently without any coaching or assistance.
Scenarios
Participants have the opportunity to demonstrate decision-making and apply their knowledge and skills in an emergency scenario conducted at the conclusion of the course. To conduct the scenario activity, have the class form pairs (or groups of three for the AED scenario), hand out scenario worksheet(s) to the groups and then communicate the setup for the scenario used. Participants then work together in pairs (in groups of three for the AED scenario) to complete the scenario. One person plays the role of the responder while the other reads the prompts from the scenario worksheet. For courses that have more than one scenario, participants should switch roles between scenarios. The groups complete the scenario(s) at the same time. During the scenarios, your focus should be on helping
CHAPTER
Criteria for Assessing Participants
11
DRAFT
participants apply the knowledge and skill(s) covered in the course to the simulated emergency situation. Step in and provide guidance only if absolutely necessary. As participants work in pairs to complete the scenario, your role is to monitor the class and provide any feedback as necessary. Although participants are expected to act on the basis of their training, they should be encouraged to work together and/or use skill sheets for reference. Because participants are going to simulate responding to a real emergency situation, the prompter should say the words in the scenario worksheet exactly as they are written. These prompts provide only the information necessary for responders to make a decision and give care. If the responder has difficulty determining the correct next step, the prompter should be encouraged to provide basic feedback, such as, That is not quite right or Remember to quickly scan for severe bleeding. Because the skills may still be relatively new, it is OK if participants hesitate, start and stop, self-correct or otherwise momentarily interrupt the skill during scenarios. To achieve course certification, participants must successfully participate in an end-of-course scenario(s). Successful participation means that a participant went through the entire scenario (either as the prompter or responder) with minimal guidance from the instructor. The goal of the scenarios is to give participants the opportunity to apply the knowledge and skills learned in the course to an emergency situation. Because this is a group activity, it is not necessary to have participants switch roles. Instead, you should conduct scenarios for each of the course components being taught. For example, if you are conducting a course that includes the first aid and CPR components, conduct one first aid scenario and one CPR scenario.
Written Exams
Written exams are a required component of the course. When administering a written exam, you must use the exam provided and may not substitute exam questions. Either exam A or exam B can be used. To pass the written exam, participants must score 80 percent or better on each exam section. If a participant does not achieve a score of 80 percent, he or she has the opportunity to take the alternative exam. Instructors may allow participants who passed the exam to review questions they missed. Graded answer sheets and written exams must be returned to the instructor. Administer only those exams for the components that are included in the course being taught.

CPRChild (correctly answer 8 out of 10 questions) CPRInfant (correctly answer 8 out of 10 questions) CPRAdult, Child and Infant (correctly answer 10 out of 12 questions) AEDAdult, Child or Infant (correctly answer 8 out of 10 questions) First Aid (correctly answer 24 out of 30 questions)
Oral exams may be given if the instructor determines that a participant has a reading or language difficulty.
Before Giving Care (correctly answer 16 out of 20 questions). This section applies to all courses but should only be used once when one or more courses are combined. CPRAdult (correctly answer 8 out of 10 questions)
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DRAFT
Criteria for Grading Participants

Course participants are assigned one of the following grades:
Successful is entered for a participant who has attended all class sessions, participated in all course activities, passed all the required course skills and passed the required scenario assessments. Unsuccessful is entered for a participant who has not met course objectives and/or does not successfully attend all class sessions, participate in all course activities, complete all the required skills and/or complete the scenario assessments and prefers not to be retested or does not pass a retest. Not Evaluated is entered as the final grade for a participant who is not attending the course with
intent to receive a completion certificate. The participant, with approval from the instructor, is allowed to choose his or her own level of participation in the course. This grade should not be substituted for Unsuccessful for a participant who attempts certification but is unable to pass the completion requirements. A participant who chooses to audit must make his or her intent known to the instructor at the beginning of the class. Make any notations that you think are necessary to record in the comments section on the Course Record, for instance, when you make accommodations, such as administering the final exam verbally.
Reporting Procedures
You must submit a completed Course Record to the Red Cross within 10 business days of course completion. The Course Record can be submitted electronically through the Red Cross Learning Center or, when using course record forms, you can send them by mail, fax or email to the Red Cross Training Support Center. Information on procedures to create and submit electronic and hard copy course records can be found on the Instructors Corner website or by calling the Red Cross Training Support Center at 1-800-RED CROSS.
Participant Course Evaluation

Gaining feedback from participants is an important step in any evaluation process. Participants should have an opportunity to tell you what they thought about the course. Have participants complete evaluations each time you teach this course. This information will provide you with feedback concerning the course and its instruction and help the Red Cross maintain the high quality of the course. A copy of the evaluation form is available on Instructors Corner.
Awarding Certicates
Upon successful completion of a course, participants will receive course completion certifications. Certifications are available in print wallet-card format or an electronic or print 8 11 format. Contact the American Red Cross Training Support Center for more information about procedures for obtaining American Red Cross course completion certificates. If you receive certificates after the course is over, make arrangements to get them to participants.
CHAPTER
Criteria for Assessing Participants
13
DRAFT
Continuing Education Units for Professionals

Many course takers are professionals who need continuing education units (CEUs) to maintain a license and/or certification. Examples include nurses, social workers, recreation professionals, teachers and day care providers. The American Red Cross is approved as an authorized provider by the International Association for Continuing Education and Training (IACET). IACETs Criteria and Guidelines for Quality Continuing Education and Training Programs are the standards by which hundreds of organizations measure their educational offerings. For additional information, go to redcross.org.
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LESSON
DRAFT
INTRODUCTION
Lesson Length: 45 minutes
MATERIALS, EQUIPMENT AND SUPPLIES

Name tags Course roster Course outline or syllabus Participants textbook Course Presentation: Part One, Introduction LCD projector, screen and computer
TOPIC:
ACTIVITY
INTRODUCTION TO THE COURSE
Time: 40 minutes
PRESENTATION: INTRODUCTION TO THE COURSE
Instructor and participant introductions: Welcome participants and introduce yourself. Have participants introduce themselves by sharing their names, their reasons for taking this course and their expectations. Use name tags if appropriate. Briefly describe your background and credentials. Identify yourself as an American Red Cross instructor and explain that this course is one of many offered by the American Red Cross. Ask participants to print their full name and address legibly on the course roster so that you can complete the American Red Cross Course Record (available on the Instructors Corner website). Orientation to the location: Point out the locations of fire exits, telephones, restrooms and drinking fountains, and explain facility rules, if there are any. Inform participants of the policy about eating, drinking or smoking in class. Identify any designated areas for these activities. Ask participants to wear comfortable clothing that will enable them to participate in skill practice sessions, as they learn how to protect themselves from disease transmission and properly move a person. Course schedule: Distribute a detailed course outline that includes dates and times of class meetings, lesson content and class assignments. Skill practice sessions and exams should be clearly identified. Course purpose: Explain that the purpose of this course is to provide citizen responders, like them, with the knowledge and skills necessary to help sustain life and minimize the consequences of injury or sudden illness until advanced medical personnel arrive. How participants will learn: Briefly explain that participants will learn through lectures, videos, discussions, reading, group activities and skill practice. Practice sessions involve practice with a partner or using a manikin. The textbook, Responding to Emergencies: Comprehensive First Aid/CPR/AED, is required reading.
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DRAFT
Participants textbook: The textbook for this course is designed to facilitate the participants learning and understanding of the information and skills required to effectively respond to emergency situations. Instruct the participants how best to use the textbook to their advantage. Point out the following features: Learn and Respond ScenariosEvery chapter begins with a brief scenario that presents an event that is related to the chapter content. At the end of the chapter, the participant is asked questions that relate back to this scenario. ObjectivesA list of objectives describes what participants should be able to do after reading the chapter and participating in class activities. Participants should read this list carefully and refer back to it when reading the chapter. These objectives form the basis for exam questions. Key TermsKey terms with their definitions appear at the beginning of each chapter and will help participants understand the chapter content. These terms are printed in boldface italics the first time they are explained in the chapter and also appear, defined, in the Glossary. Glossary TermsThese terms are printed in boldface the first time they are introduced in a chapter. They are defined in the Glossary. Tables, Boxes and FiguresTables concisely summarize important concepts and information and may aid studying. Boxes contain information that may be useful or of interest. These include What if? boxes that highlight specific situations you may encounter in real life. These appear throughout the textbook. Figures are the photographs, drawings, charts and graphs that appear in all chapters, illustrating skills, concepts and anatomical features. Captions highlight the relevant information in figures. Smart Moves Prevention BoxesSome chapters include Smart Moves Prevention Boxes highlighting steps that can be taken to prevent or lower the risk of an emergency from happening in the first place. SidebarsFeature articles called sidebars enhance the information in the main body of the textbook. They appear in most chapters. Participants will not be tested on any information contained in sidebars. Ready to Respond QuestionsReady to Respond questions, found at the end of each chapter, challenge participants to apply the information they learned to the scenarios at the beginning of each chapter. Answers to the questions are located in Appendix B of the textbook. Study QuestionsAt the end of each chapter are a series of study questions designed to test retention and understanding of the chapter content. Completing these questions will help evaluate how well participants understand the material and also help them prepare for the final written exams. Answers to the study questions are located in Appendix B of the textbook. Skill SheetsSkill sheets at the end of certain chapters give step-by-step direction for performing specific skills and include photographs of key steps. Course completion requirements: Describe the Red Cross requirements for successful course completion. To successfully complete this course and receive an American Red Cross certificate, the participant must: Correctly answer at least 80 percent or better in the appropriate sections on the final written exam(s). Participate in all skill sessions and scenarios. Demonstrate competency in all required skills.
Instructors Note: If there are academic, state or local requirements beyond the minimum Red Cross course completion requirements, explain them to participants at this time. These requirements should be explained in the course syllabus.
LESSON
Introduction
19
DRAFT
The academic requirements for receiving a grade in this course should be established by your institution. See Chapter 4 of this manual for more information concerning setting course completion requirements.
TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
You are taking this course to learn how to act appropriately and confidently in emergency situations. Preventing emergencies is always more desirable than having to give first aid. Lifestyle changes we make now can prevent future injury or sudden illness. Answer participants questions. If Lesson 2 is being taught next: Complete the Healthy Lifestyles Awareness Inventory (Instructors Corner). If Lesson 3 is being taught next: Read Chapter 1 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 2
HEALTHY LIFESTYLES (OPTIONAL)

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Evaluate their lifestyles using the Healthy Lifestyles Awareness Inventory and be familiar with the factors that have an impact on behavior modication.
GUIDANCE FOR THE INSTRUCTOR

To complete this lesson and meet the lesson objectives, you must: Have participants complete the Healthy Lifestyle Awareness Inventory. Identify ways to make lifestyle changes. Encourage participants to develop a behavior modication contract.

Participants textbook Healthy Lifestyles Awareness Inventory (Instructors Corner) Behavior Modication Contract (Instructors Corner) Course Presentation: Part One, Healthy Lifestyles LCD projector, screen and computer
TOPIC:
EVALUATING YOUR LIFESTYLE

Time: 15 minutes
DISCUSSION PRESENTATION: EVALUATING YOUR LIFESTYLE
A healthy lifestyle is a combination of positive beliefs and practices. Knowledge of healthy lifestyles and practices will guide personal actions and habits. Personal beliefs and practices can increase or decrease risks of injury or sudden illness. Lifestyle changes we make now can prevent future injury or illness.
Instructors Note: The information in the textbook that correlates with this lesson appears in Appendix A.
LESSON
Healthy Lifestyles (OPTIONAL)
21
DRAFT
EVALUATING YOUR LIFESTYLE Continued HEALTHY LIFESTYLES AWARENESS INVENTORY
ACTIVITY

Have participants complete the Healthy Lifestyles Awareness Inventory (if not completed as an assignment before class). Upon completion, ask them to add up their scores and record them on the Healthy Lifestyles Scorecard. Tell participants that they do not have to put their name on the scorecard. Collect the completed, unsigned scorecards. Explain to participants that all of the scores will be added together, and then averaged for a total class score. This activity will be completed again, at the end of the course, to determine if there has been a change in group behavior. Answer participants questions.
TOPIC:
MAKING LIFESTYLE CHANGES
Time: 25 minutes
MODIFYING BEHAVIORS
DISCUSSION PRESENTATION: MODIFYING BEHAVIORS

Lifestyle changes require changes in behaviors. For changes to be successful: An individual must want to change. The desire to change must be accompanied by a change in attitude. Changes in attitude must persist for long-term changes in behavior to succeed.
STRATEGIES FOR SUCCESSFUL BEHAVIOR CHANGES

DISCUSSION PRESENTATION: STRATEGIES FOR SUCCESSFUL BEHAVIOR CHANGES

Evaluate pros and cons of current habits to determine what behaviors you want to change. Set short- and long-term goals. Use positive rewards for achieving both short- and long-term goals. Avoid situations that promote behaviors you are trying to change. Reinforce commitment to change by keeping your goal in front of you (post it on your refrigerator, bathroom or dresser mirror, and so on). Use the support of others. Get professional help if needed.
DEVELOPING A BEHAVIOR MODIFICATION CONTRACT

ACTIVITY PRESENTATION: DEVELOPING A BEHAVIOR MODIFICATION CONTRACT
Ask participants to form small groups of three to four people. Have them discuss the results of each participants inventory to identify areas where improvement is possible. Ask each participant to identify an area that he or she wants to improve. The group members will work as a team to help each other identify a measurable goal and objective(s) for improvement in that area during the course. If you wish, have the participants record their individual goals, objectives and measures on a Behavior Modification Contract (Instructors Corner). Ask the participants how they feel about making a commitment like this. Ask them what roadblocks they anticipate to being successful.
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DRAFT TOPIC:
ACTIVITY ASSIGNMENT
CLOSING

Time: 5 minutes
Answer participants questions. Read Chapter 1 and complete the questions at the end of the chapter.
LESSON
Healthy Lifestyles (OPTIONAL)
23
LESSON
DRAFT
IF NOT YOU . . . WHO?

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe two types of emergencies that require rst aid. Describe their role in an emergency situation. Identify the most important action(s) they can take in a non-life-threatening emergency. List seven common barriers to act that may prevent people from responding to emergencies. Identify ve ways bystanders can help at the scene of an emergency. Recognize the signals of incident stress and when they may need help to cope.

To complete this lesson and meet the lesson objectives, you must: Describe an emergency. Review the types of emergencies requiring rst aid. Explain the role of the emergency medical services (EMS) system. Discuss the persons role in an emergency, emphasizing that recognizing an emergency is the rst step toward taking appropriate action. Show the video segments, Introduction and What Would You Do? Identify the barriers to act. Describe incident stress.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Course Presentation: Part One, If Not You ... Who? Participants textbook LCD projector, screen and computer
TOPIC:
VIDEO
INTRODUCTION
Time: 5 minutes
Show the video segment, Introduction (2:13).
PRESENTATION: INTRODUCTION
DISCUSSION PRESENTATION: INTRODUCTION
An emergency is a situation requiring immediate action. An emergency can happen at any place (on the road, in your home, where you work), to anyone (a friend, relative, stranger) and at any time. Your decision to act and the care provided may help save a life.
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DRAFT TOPIC:
RESPONDING TO EMERGENCIES
Time: 5 minutes
TYPES OF EMERGENCIES
DISCUSSION PRESENTATION: TYPES OF EM ERGENCIES

There are two types of emergencies that require first aid: An injury is damage to the body from an external force, such as a broken bone from a fall. A sudden illness, such as heart attack or a severe allergic reaction, is a physical condition that requires immediate medical attention. Emergencies can be further categorized as life-threatening and non-life-threatening: A life-threatening emergency is an injury or illness that impairs a persons ability to circulate oxygenated blood to all the parts of his or her body. A non-life-threatening emergency is a situation that does not have an immediate impact on a persons ability to circulate oxygenated blood, but still requires medical attention.
THE EMS SYSTEM

DISCUSSION PRESENTATION: THE EMS SYSTEM
The emergency medical services (EMS) system is a network of community resources and medical personnel that provides emergency care to people who have been injured or are experiencing sudden illness. The EMS system is a chain made up of several links, with each link depending on the others for success. Without the involvement of lay responders such as you, the EMS system cannot function effectively.
YOUR ROLE IN AN EMERGENCY

DISCUSSION PRESENTATION: YOUR ROLE IN AN EM ERGENCY

Your primary role as a lay responder in an emergency includes: Recognizing that an emergency exists. Deciding to act. Activating the EMS system by calling 9-1-1 or the local emergency number. Giving care until medical help arrives and takes over. The ability to recognize that an emergency has occurred is the first step toward taking appropriate action. You may become aware of an emergency from certain indicators: unusual noises, sights, odors, appearances or behaviors.
TOPIC:
DECIDING TO ACT

Time: 10 minutes
DISCUSSION PRESENTATION: DECIDING TO ACT
Once you recognize that an emergency has occurred, you must decide how to help and what to do. Calling 9-1-1 or the local emergency number is the most important action you and other lay responders can take. Early arrival of EMS personnel increases the persons chance of surviving a life-threatening emergency.
LESSON
If Not You . . . Who?
25
DRAFT
DECIDING TO ACT Continued
VIDEO PRESENTATION: WHAT WOULD YOU DO? ACTIVITY
Tell participants that they are about to see a video showing an emergency situation. At the end of the video segment, you will ask them to answer a few questions about the situation they saw. Show the video segment, What Would You Do? (1:36). Facilitate a discussion about the video segment by asking the following questions: How do you feel about what you just saw in this video segment? How many of you feel you would respond to this emergency? Those of you who would not respond, why not? Can anyone think of any other reasons that might discourage a person from responding?
Instructors Note: Participants may or may not feel comfortable responding to these questions. Be sensitive to each response. If a response seems odd to you or to the other participants, reinforce that some barriers to act are personal. A barrier to one person may not be a barrier to another. Dispel myths that surface in the discussion.
TOPIC:
OVERCOMING BARRIERS TO ACT

Time: 15 minutes
DISCUSSION PRESENTATION: OVERCOM ING BARRIERS TO ACT
Sometimes, people simply do not recognize that an emergency has occurred. At other times, people recognize an emergency but are reluctant to act. Reasons people give for hesitating or not acting are called barriers to act.
PANIC OR FEAR OF DOING SOMETHING WRONG

DISCUSSION PRESENTATION: PANIC OR FEAR OF DOING SOM ETHING WRONG

People react differently in emergencies. Some people are afraid of doing the wrong thing and making matters worse; others may simply panic. Knowing what to do in an emergency can instill confidence that can help you to avoid panic and be able to give the right care. If you are unsure of what to do during an emergency, call 9-1-1 or the local emergency number and follow the instructions of the emergency medical dispatcher (EMD). The worst thing to do in an emergency is nothing.
BEING UNSURE OF THE PERSONS CONDITION AND WHAT TO DO

DISCUSSION PRESENTATION: BEING UNSURE OF THE PERSONS CONDITION

Since most emergencies happen in or near the home, you are more likely to give care to a family member or a friend than to a stranger. If the person is a stranger, you may feel uneasy about helping someone whom you do not know. Sometimes, people who have been injured or become suddenly ill may act strangely or be uncooperative. If at any time you feel threatened by the persons behavior, leave the immediate area and call 9-1-1 or the local emergency number for help.
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DRAFT
OVERCOMING BARRIERS TO ACT Continued ASSUMING SOMEONE ELSE WILL TAKE ACTION
DISCUSSION PRESENTATION: ASSUM ING SOM EONE ELSE WILL TAKE ACTION

Never assume that just because a crowd has gathered that someone is caring for the injured or ill person. Always ask if you can help. You may feel embarrassed about coming forward in front of other people. Do not let this feeling stop you from helping. Someone has to take action in an emergency and it may have to be you. If others are already giving care, offer to help. If bystanders do not appear to be helping, tell them how to help such as by: Asking them to call 9-1-1 or the local emergency number. Having them meet the ambulance and directing it to your location. Telling them to keep the area free of onlookers and traffic. Sending them for blankets or other supplies, such as a first aid kit or an automated external defibrillator (AED). Asking them to help give care.
TYPE OF INJURY OR ILLNESS

DISCUSSION PRESENTATION: TYPE OF INJURY OR ILLNESS

An injury or illness sometimes may be very unpleasant to handle. You cannot always predict how you will respond to disturbing factors, such as blood, vomit, unpleasant odors, deformed limbs or torn or burned skin. Sometimes, you may need to compose yourself before acting. Take a few deep breaths and then give care. If you are still unable to give care, help in other ways such as volunteering to call 9-1-1 or the local emergency number.
FEAR OF DISEASE
DISCUSSION PRESENTATION: FEAR OF DISEASE

Many people worry about the possibility of being infected with a disease while giving care. Although it is possible for diseases to be transmitted in a first aid situation, it is extremely unlikely that you will catch a disease in this way. Later in this course, you will learn how to take steps, such as handwashing and using protective barriers, to prevent disease transmission.
FEAR OF BEING SUED

DISCUSSION PRESENTATION: FEAR OF BEING SUED

Sometimes, people worry that they might be sued for giving care. Lawsuits against people who give emergency care at a scene of an accident are highly unusual and rarely successful. All states have enacted Good Samaritan laws that protect people who willingly give first aid without accepting anything in return.
BEING UNSURE OF WHEN TO CALL 9-1-1 OR THE LOCAL EMERGENCY NUMBER

DISCUSSION PRESENTATION: BEING UNSURE OF WHEN TO CALL 9-1-1
People sometimes are afraid to call 9-1-1 or the local emergency number because they are not sure that the situation is a real emergency and do not want to waste the time of the EMS personnel. Your decision to act in an emergency should be guided by your own values and by your knowledge of the risks that may be present. Even if you decide not to give care, you should at least call 9-1-1 or the local emergency number to get emergency medical help to the scene.
LESSON
27
DRAFT TOPIC:
ACTIVATING THE EMS SYSTEM AND GIVING CARE
Time: 5 minutes
DISCUSSION PRESENTATION: ACTIVATING THE EMS SYSTEM AND GIVING CARE
Calling 9-1-1 or the local emergency number is the most important action you can take in an emergency. Early arrival of EMS personnel increases the persons chances of surviving a life-threatening emergency. Remember, some facilities such as hotels, office and university buildings and some stores require you to dial a 9 or some other number to get an outside line before you dial 9-1-1 (i.e., dial 9-9-1-1). There are also a few areas that still are without access to a 9-1-1 system and so have a local emergency number instead. Become familiar with the system where you live and where you spend your school or work hours. When you dial 9-1-1 or the local emergency number, your call will normally be answered by an Emergency Medical Dispatcher (EMD). An EMD has special training in dealing with crises over the phone and providing pre-arrival medical instructions. The first question the EMD will ask is, Where is your emergency (i.e. address), and your phone number. The EMD will also ask key questions to determine whether you need police, fire or EMS assistance. Do not hang up until the EMD directs you to do so. While waiting for EMS to arrive, always follow the pre-arrival instructions provided by the EMD You should give appropriate care to an injured or ill person until one or more of the following occurs: You are giving cardiopulmonary resuscitation (CPR) and see an obvious sign of life, such as breathing. Another trained responder or EMS personnel take over. You are too exhausted to continue. The scene becomes unsafe. The person you are helping is conscious and competent and asks you to stop giving care.
Instructors Note: Legal considerations for giving care, including obtaining consent and refusal of care are covered in Lesson 5.
TOPIC:
INCIDENT STRESS

Time: 3 minutes
DISCUSSION PRESENTATION: INCIDENT STRESS
After responding to an emergency involving a serious injury, illness or death, it is not unusual to experience acute stress. Sometimes, people who have given first aid or performed CPR in these situations feel that they are unable to cope with the stress. This is known as incident stress. Signals of incident stress include: Anxiousness and inability to sleep. Nightmares. Restlessness and other problems. Confusion. Lower attention span.
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DRAFT
INCIDENT STRESS Continued
Poor concentration. Denial. Guilt. Depression. Anger. Nausea. Change in interactions with others. Increased or decreased eating. Uncharacteristic, excessive humor or silence. Unusual behavior. Difficulty performing ones job. Incident stress may require professional help to prevent post-traumatic stress from developing. Things you may do to help reduce stress include: Relaxation techniques. Eating a balanced diet. Avoiding alcohol and drugs. Getting enough rest. Participating in some type of physical exercise or activity.
TOPIC:
CLOSING

Time: 3 minutes
DISCUSSION
An emergency can happen at any place, to anyone and at any time. You, the lay responder trained in first aid, play a critical role when an emergency occurs. Your actions can help save a life. Learning to recognize an emergency and, more importantly, deciding to act by calling 9-1-1 or the local emergency number, and giving care are the most important actions you can take to help save the life of a person with an injury or sudden illness. Once you have taken care of the injured or ill person, remember to also consider your own feelings about the emergency situation. Answer participants questions. Review Chapter 1. Read Chapter 2 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
LESSON
29
LESSON
DRAFT
TAKING ACTION
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify and describe the three emergency action steps. Explain when and how to call 9-1-1 or the local emergency number.

To complete this lesson and meet the lesson objectives, you must: Review the important components of being prepared for emergencies. Discuss the actions involved in each of the emergency action steps. Distinguish between Call First and Care First situations.

Participants textbook Course Presentation: Part One, Taking Action LCD projector, screen and computer Written handouts of scenarios (optional) Newsprint or chalkboard (optional) Markers or chalk (optional)
TOPIC:
INTRODUCTION

Time: 2 minutes
An emergency scene can be overwhelming. By learning how to check an emergency scene and prioritize your actions, you will be able to respond effectively in any emergency situation.
TOPIC:
UNTIL HELP ARRIVES
Time: 10 minutes
DISCUSSION
Always follow the pre-arrival instructions provided by the Emergency Medical Dispatcher (EMD) while waiting for EMS and other public safety professionals to arrive. Instructions may range from taking action that makes the scene safer and more accessible for EMS personnel to giving care.
Instructors Note: Remember that participants have not yet been introduced to the emergency action steps: CHECKCALLCARE. The emergency action steps will be introduced later in this lesson.
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DRAFT
UNTIL HELP ARRIVES Continued
ACTIVITY PRESENTATION: UNTIL HELP ARRIVES
Explain to participants that helping at an emergency scene does not always mean giving direct care to the person(s). Explain that you should ask yourself, In what other ways can I give help? Have participants read Scenario 1 described on the presentation slide.
Instructors Note: If you are using the presentation slides, show scenario 1 on the monitor for the participants to read. If you are not using the presentation slides, read scenario 1 to the participants, write the scenario on the chalkboard or newsprint, or supply the participants with a written handout of the scenario. Scenario 1 A motorcycle with two riders weaves dangerously between parked cars in a crowded shopping center parking lot. As the motorcyclists dart between cars, they confront a moving car. Both the car and motorcycle veer to avoid a head-on collision. The motorcycle strikes the side of the oncoming car, throwing the riders to the ground. The car stops abruptly, throwing the driver into the windshield. Nearby, Jamie and Paul (two college students) hear the sound of crunching metal and blaring horns and decide to join the small group that has gathered. As they approach the scene, they are confronted with the sight of broken glass, strewn metal and a cracked windshield. A gas cap lies nearby, and they notice what appears to be gasoline that has spilled from the motorcycle onto the roadway. One person screams in pain as she sits holding her injured arm. The other person lies motionless. Two people wearing safety belts are inside the stopped car. The driver appears to be shaken. Several onlookers turn away, apparently unable to cope with what they see. Other bystanders continue to gather. As Jamie and Paul look around, no one seems to be helping. They hesitate, wondering whether they should step forward to help. Ask participants to list the steps they would take to help at this particular scene. If you are using newsprint or chalkboard, record the participants responses. Ask them what actions they should take first. Expect disagreement among the participants. After several minutes of discussion about their actions, explain to participants that different situations may change the order in which actions are carried out. For instance, if the scene is unsafe, you should call 9-1-1 or the local emergency number first. In a situation where the scene is safe, you might not call 9-1-1 until you check the person(s). Sometimes, these actions can happen simultaneously. For instance, you might send someone else to call the emergency number while you check the injured or ill person(s). Wrap up the discussion by explaining that, as a rule, the safety of the responders, persons and bystanders should always come first, and life-threatening conditions should be cared for before conditions of lesser urgency.
TOPIC:
EMERGENCY ACTION STEPS
Time: 15 minutes
DISCUSSION
PRESENTATION: EM ERGENCY ACTION STEPS
The emergency action steps are the three steps you should take in any emergency. The steps are: CHECK the scene for safety and the person for life-threatening conditions. CALL 9-1-1 or the local emergency number. CARE for the person(s).
LESSON
Taking Action
31
DRAFT
CHECK
ACTIVITY

Briefly review the list of participant responses from the previous scenario regarding what steps to take in an emergency until help arrives. Group the responses into the emergency action steps: CHECKCALLCARE. Use this list to reinforce that an emergency scene can be not only overwhelming, but also confusing. Explain to participants that you are going to present them with the same emergency scenario they just read. After they have heard and read the scenario again, you will guide a discussion of how the emergency action steps apply to the emergency scene.
ACTIVITY
PRESENTATION: CHECK
Instructors Note: Use the same scenario 1 presented above. Have the student read it again in full, or read it to them again in full. Ask participants to state the emergency action steps in order. As they state each step, write it on newsprint or a chalkboard. Guide a discussion based on the following questions for each of the emergency action steps: CHECK the scene. Is the scene safe? Check for anything unsafe such as spilled chemicals, traffic, fire, escaping steam, downed electrical lines, smoke or extreme weather. In an emergency involving a motor vehicle, scene safety issues can also arise if the car ignition is still on and the parking brake is not engaged; the car is unstable; there are undeployed airbags; or the car is a hybrid, in which case there could be additional electrocution hazards. If there is spilled gasoline or other similar substances, check if there is a possibility they could explode. If the scene is unsafe, do not approach. Call 9-1-1 or the local emergency number immediately. Is immediate danger involved? Do not move a seriously injured person unless there is an immediate danger (such as fire, flood or poisonous gas); you have to reach another person who may have a more serious injury or illness; or you need to move the injured person to give proper care and you are able to do so without putting yourself in danger. If you must move the person, do it as quickly and carefully as possible. If there is no immediate danger, tell the person to remain still until you can assess his or her condition. Tell any bystanders not to move the person. What happened? Look for clues as to what caused the emergency and how the person(s) might have been injured. If there are no bystanders, your check of the scene may be the only way to tell what happened. How many people are involved? Look carefully for more than one person. If one person is bleeding or screaming, you might not notice an unconscious person right away. It also is easy to overlook a small child or an infant. In an emergency with more than one injured or ill person, you may need to prioritize care based on the severity of the injuries or illness.
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DRAFT
CHECK Continued
Are bystanders available to help? Remember, the presence of bystanders does not mean a person is receiving help. You may have to ask bystanders to help. Bystanders may be able to tell you what happened or make the call for help while you provide care. If a family member, friend or co-worker is present, he or she may know if the person is ill or has a medical condition.
ACTIVITY
Explain to participants that the scenario is continuing:
PRESENTATION: CHECK
Instructors Note: If you are using the presentation slides, show scenario 2 on the monitor for the participants to read. If you are not using the presentation slides, read scenario 2 to the participants, write the scenario on the chalkboard or newsprint or supply the participants with a written handout of the scenario. Scenario 2 Jamie instructs bystanders to stop trafc. Paul tells the people in the car to turn off the engine and apply the parking break. The leaking gas from the motorcycle is not close to the motorcycle driver and passenger. Jamie checks the motorcycle driver and determines he is unconscious and instructs someone to call 9-1-1 or the local emergency number. She then continues her check of the person to determine if he is breathing. The two people in the car are conscious and talking to Paul. The other motorcyclist, still screaming, is attended to by another rescuer who helps control the bleeding from the persons arm. Guide a discussion based on the following questions for the next part of the emergency action steps: CHECK the person. What is wrong? What signals may indicate a life-threatening emergency. First check to see if the injured or ill person is conscious. If so, reassure him or her and try to find out what happened. If a person is lying on the ground, silent and not moving, he or she may be unconscious. Tap him or her on the shoulder and ask if he or she is ok. Speak loudly. For an infant, ask loudly if the infant is ok and flick the bottom of the infants foot to see if the infant responds. If a person does not respond in any way, assume he or she is unconscious, which is always considered life-threatening. Make sure that someone calls 9-1-1 or the local emergency number right away. Look for other signals of life-threatening injuries including trouble breathing, the absence of breathing or breathing that is not normal and/or severe bleeding. Use your senses of sight, smell and hearing when checking. Which people were checked for life-threatening emergencies? Why werent all people checked for life-threatening emergencies? Discuss the emergency action step: CALL 9-1-1 or the local emergency number. At what point did someone call 9-1-1 or the local emergency number? Was this the right time for the call to be made? What information should the person calling 9-1-1 or the local emergency number be prepared to give?
LESSON
Taking Action
33
DRAFT
CHECK Continued
What could you do to ensure that 9-1-1 or the local emergency number has been called? What if you are not sure? Where else might the caller have found a phone? Discuss the emergency action step: Give CARE until EMS personnel arrive. What care was given for the people?
TOPIC:
CALL AND CARE

Time: 12 minutes
DISCUSSION
As a lay responder, your top priority is to ensure that the person receives more advanced care as soon as possible. The EMS system works most effectively if you can give information about the persons condition when the call is placed.
WHEN TO CALL
DISCUSSION

PRESENTATION: WHEN TO CALL
At times, you may be unsure if EMS personnel are needed. As a general rule, call 9-1-1 or the local emergency number if the person has any of the following conditions: Unconsciousness or an altered level of consciousness (LOC), such as drowsiness or confusion Breathing problems (trouble breathing or no breathing) Chest pain, discomfort or pressure lasting more than a few minutes; that goes away and comes back; or that radiates to the shoulder, arm, neck, jaw, stomach or back Persistent abdominal pain or pressure Severe external bleeding (bleeding that spurts or gushes steadily from a wound) or internal bleeding (bleeding inside the body, which may be difficult to recognize) Vomiting blood or passing blood Severe (critical) burns Suspected poisoning Seizures Stroke (sudden weakness on one side of the face/facial droop, sudden weakness on one side of the body, sudden slurred speech or trouble getting words out or a sudden, severe headache) Suspected or obvious injuries to the head, neck or spine Painful, swollen, deformed areas (suspected broken bone) or an open fracture Also call 9-1-1 or the local emergency number immediately for any of these situations: Fire or explosion Downed electrical wires Swiftly moving or rapidly rising water Presence of poisonous gas Serious motor-vehicle collisions Injured or ill persons who cannot be moved easily
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DRAFT
MAKING THE CALL
DISCUSSION PRESENTATION: MAKING THE CALL
When calling 9-1-1 or the local emergency number, the EMD will ask many questions including the location as well as the telephone number and address from which the call is made, the callers name, what happened, number of persons involved, the condition of the person(s), and the care being given. If you are calling from a land line phone, your location and telephone number may be automatically transmitted to the dispatcher. This technology, called Enhanced 9-1-1 (E9-1-1), can save valuable time in an emergency and get resources to the scene faster. As the FCCs wireless E-9-1-1 rules continue to take effect, wireless phones are also beginning to provide more precise location information. However, this service is not yet available everywhere, and even with the best technology currently available, accuracy is only within 50 to 300 meters. If you are alone, you must make a decision about when to place the call to activate the EMS system. Call First; that is, call 9-1-1 or the local emergency number before giving care for the following: An unconscious adult or adolescent age 12 years or older. A witnessed sudden collapse of a child (112 years of age) or infant (<1 year of age). An unconscious child or infant known to have heart (cardiac) problems. Call First situations are likely to be cardiac emergencies, such as sudden cardiac arrest, where time is critical. Care First; that is, provide 2 minutes of care and then call 9-1-1 for the following: An unconscious person younger than 12 years of age who you did not see collapse. Any person who had a drowning incident. Care First situations are likely to be related to breathing emergencies rather than sudden cardiac arrest.
CARE
DISCUSSION PRESENTATION: CARE

After you have checked the scene and the person and have made a decision about calling 9-1-1 or the local emergency number, you may need to provide care. Always care for life-threatening conditions first. While waiting for more advanced medical help, follow these general guidelines: Do no further harm. Monitor the persons level of consciousness and breathing. A change in the persons condition may be a signal of a more serious injury or illness. Help the person rest in the most comfortable position. Keep the person from getting chilled or overheated. Comfort and reassure the person, but do not provide false hope. Give any specific care as needed.
LESSON
Taking Action
35
DRAFT TOPIC:
TRANSPORTING THE PERSON YOURSELF

Time: 3 minutes
DISCUSSION PRESENTATION: TRANSPORTING THE PERSON YOURSELF
In some cases, you may decide to take the injured or ill person to a medical facility yourself. Never transport a person when the trip may aggravate the injury or illness or cause worsening of the condition, when the person has or may develop a life-threatening condition, or if you are unsure of the nature of the injury or illness. If you decide it is safe to transport the person, ask someone to come with you to keep the person comfortable. Pay close attention to the injured or ill person and watch for any changes in his or her condition. Discourage an injured or ill person from driving him- or herself to the hospital or physician. An injury may restrict movement or the person may become groggy or faint. A sudden onset of pain may be distracting. Any of these conditions can make driving very dangerous for the person, passengers, other drivers and pedestrians.
TOPIC:
CLOSING

Time: 3 minutes
DISCUSSION
The emergency action steps: CHECKCALLCARE will guide your actions in any emergency. If you are in a situation in which you are the only person other than the injured or ill person, you must make a decision to Call First or Care First. Answer participants questions. Read Health Precautions and Guidelines During Training in Appendix B of the textbook. Read Chapter 3 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 5
BEFORE GIVING CARE

LESSON OBJECTIVES
After completing the lesson, participants should be able to: List four conditions that must be present for disease transmission to occur. Identify two ways in which a pathogen can enter the body. Describe how to minimize the risk of disease transmission when giving care in a situation that involves visible blood. Describe the difference between expressed consent and implied consent. Describe the purpose of Good Samaritan laws. List six situations in which moving a person is necessary. List ve limitations they should be aware of before they attempt to move someone. Describe six ways to move a person. After completing the skill session, participants should be able to: Demonstrate how to remove disposable gloves.

To complete this lesson and meet the lesson objectives, you must: Review disease transmission and how to prevent it. Conduct the skill session for removing disposable gloves. Discuss how to obtain consent to give care. Review Good Samaritan laws. Describe the emergency moves that can be used to move a person.

Participants textbook Course Presentation: Part One, Before Giving Care LCD projector, screen and computer Skill Chart: Removing Gloves Skill Assessment Tool: Removing Gloves Nonlatex disposable gloves (multiple sizes) Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 3 minutes
In any emergency situation, your top priority is to ensure your own safety. This includes protecting yourself from disease transmission and knowing how to properly move a person. You also need to know some basic legal information before giving care.
LESSON
Before Giving Care
37
DRAFT TOPIC:
PREVENTING DISEASE TRANSMISSION

Time: 15 minutes
DISCUSSION PRESENTATION: PREVENTING DISEASE TRANSM ISSION
Bloodborne pathogens, such as bacteria and viruses, are present in blood and body fluids and can cause disease. Because some infectious diseases like hepatitis and human immunodeficiency virus (HIV) are very serious, you must learn how to protect yourself and others from disease transmission, or prevent the passage of disease from one person to another, while helping a person who has been injured or is ill. The disease process begins when a pathogen enters the body. When pathogens enter the body, they can sometimes overpower the bodys natural defense systems and cause illness. This type of illness is called an infection. Most infectious diseases are caused by bacteria and viruses. For any disease to spread, four conditions must be met: A pathogen is present. Enough of the pathogen is present to cause infection. The pathogen passes through a correct entry site (eyes, mouth, and other mucous membranes, or skin that has been pierced or broken by cuts, abrasions, bites and sharp objects). A person is susceptible to the pathogen. Diseases can be spread through direct contact transmission and indirect contact transmission with infected blood or other body fluids. Direct contact transmission occurs when the infected blood or body fluids from one person enter another persons body at an entry site. Indirect contact transmission occurs when a person touches an object that contains blood or another body fluid of an infected person, such as soiled dressings, equipment or work surfaces, and infected blood or other body fluid enters the body through a correct entry site. Standard precautions are safety measures taken to prevent exposure to blood and body fluids when giving care to injured or ill persons. It considers all body fluids and substances as infectious. These precautions and practices include: Good personal hygiene habits, such as frequent hand washing with soap and water or alcohol-based hand sanitizers. Personal protective equipment (PPE), such as disposable gloves (nitrile, vinyl or non-latex) and breathing barriers used when performing rescue breaths. Cleaning up after providing care or a blood spill includes thoroughly cleaning and disinfecting all surfaces that may have come into contact with the injured or ill person or materials that may have become contaminated while providing care. Blood spills are to be cleaned up immediately or as soon as possible after the spill occurs while using disposable gloves and other PPE and then disposing of the contaminated material used for clean up in a labelled biohazard container. To learn more about preventing disease transmission, enroll in an American Red Cross Bloodborne Pathogens Training course.
Instructors Note: For more information on online and classroom courses for Bloodborne Pathogens Training, suggest that participants visit Redcross.org. You may want to show the optional video segment Bloodborne Pathogens Training: Preventing Disease Transmission (16:59). Guide the participants to Chapter 3 of the textbook for proper hand-washing techniques, using PPE, the general steps for cleaning up a blood or other body uid spill and other precautions, including what to do in case of exposure.
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DRAFT
PREVENTING DISEASE TRANSMISSION Continued
SKILL SESSION: REMOVING GLOVES

Tell participants that they will practice removing their gloves using the skill chart in Chapter 3 of the textbook. Guide participants through the skill. Give help when appropriate or when requested. Record participants successful completion on the Participant Progress Log (Appendix E or Instructors Corner).
Instructors Note: Demonstrate how to remove disposable gloves before the participants practice.
TOPIC:
OBTAINING CONSENT TO GIVE CARE

Time: 10 minutes
DISCUSSION PRESENTATION: OBTAINING CONSENT TO GIVE CARE
People have a basic right to decide what can and cannot be done to their bodies and they have the legal right to accept or refuse emergency care. Before giving care to an injured or ill person, you must get his or her permission or consent. To get consent, you must: Identify yourself to the person. Give your level of training. Ask the person whether you may help. Explain what you observe. Explain what you plan to do. When a conscious, competent adult understands your questions and what you plan to do, and then gives you permission to give care, this is called expressed consent. Expressed consent can be verbal, nonverbal or through gestures. If the person is a child or infant, you must obtain consent from the parent or guardian. If a conscious, competent person refuses care, do not touch or give care. However, you should still call 9-1-1 or the local emergency number. If a person is unable to give expressed consent, such as when the person is unconscious or unable to respond, confused, mentally impaired, seriously injured or seriously ill, the law assumes that if the person could respond, he or she would agree to care. This is called implied consent. Implied consent applies to a child or infant if a parent or guardian is not present or immediately available. Once you begin giving care, you are legally obligated to continue that care until a person with equal or higher training relieves you, you are physically unable to continue or a competent person refuses care. Usually, your obligation for care ends when more advanced medical professionals take over. If you stop care before that point without a valid reason, you could be legally responsible for the abandonment of a person in need.
LESSON
Before Giving Care
39
DRAFT TOPIC:
GOOD SAMARITAN LAWS
Time: 5 minutes
DISCUSSION PRESENTATION: GOOD SAMARITAN LAWS
The vast majority of states and the District of Columbia have enacted Good Samaritan laws that give legal protection from claims of negligence to people who willingly give emergency care to injured or ill persons without accepting anything in return. Good Samaritan immunity generally prevails when an individual responds to an emergency and acts as a reasonable and prudent person would under the same conditions. For example: Moving a person only if his or her life was endangered. Asking a conscious person for consent before giving care. Checking the person for life-threatening emergencies before giving further care. Calling 9-1-1 or the local emergency number. Continuing to give care until more highly trained personnel arrive. Good Samaritan laws require that the Good Samaritan responder use common sense and a reasonable level of skill, not to exceed the scope of the individuals training in emergency situations.
Instructors Note: If possible, have a copy of the local laws to share with participants or a general understanding of the laws to aid discussion. If participants are interested in nding out more about their states Good Samaritan laws, recommend that they contact a legal professional, state attorney generals ofce or check their local library.
TOPIC:
REACHING AND MOVING A PERSON
Time: 10 minutes
DISCUSSION PRESENTATION: REACHING AND MOVING A PERSON
In most cases, you can follow the emergency action steps by checking the scene and the person, calling 9-1-1 or the local emergency number and caring for the injured or ill person where you find him or her. Sometimes, you cannot give care because a person is inaccessible. You must immediately begin to think of how to safely gain access to the person. You should only do what you are trained to do, have appropriate equipment for and can safely do. One of the most dangerous threats to a seriously injured or ill person is unnecessary movement. Moving a person needlessly can lead to further injury and pain and can complicate recovery. You should move a person only when you can do so safely and only in one of the following three situations: When you are faced with immediate danger, such as fire, lack of oxygen, risk of explosion or a collapsing structure; and only if you can move the person without putting yourself at risk. Otherwise, you should call 9-1-1 or the local emergency number. When you have to get to another person who may have a more serious problem. When it is necessary to give proper care, such as if a person needs CPR, he or she might have to be moved from a bed because CPR needs to be performed on a firm, flat surface. Before you act, consider the following limitations to moving one or more persons quickly and safely: Dangerous conditions at the scene. The size of the person. The distance the person must be moved.
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DRAFT
REACHING AND MOVING A PERSON Continued
Your physical ability. Whether others (bystanders) can help you. The persons condition. Any aids or equipment to facilitate moving the person at the scene.
EMERGENCY MOVES
DISCUSSION PRESENTATION: EM ERGENCY MOVES

There are several ways to move a person to safety if necessary. No one way is best for every situation. To protect yourself and the person, follow these guidelines when moving the person: Use your legs, not your back, when you bend. Bend at the knees and hips and avoid twisting your body. Maintain a firm grip on the person. Walk forward when possible, taking small steps and looking where you are going to maintain a firm footing. Avoid twisting or bending anyone with a possible head, neck or spinal injury. Do not move a person who is too large to move comfortably. Use good posture. Six common types of emergency moves that can be done by one or two people and with minimal to no equipment are: Walking AssistDo with one or two responders for a conscious person. It is not appropriate to do if you suspect that the person has a head, neck or spinal injury. Two-Person Seat CarryDo with two responders for a conscious person who is not seriously injured. It is not appropriate to do this if you suspect that the person has a head, neck or spinal injury. Pack-Strap CarryDo with one or more responders for a conscious or unconscious person. If doing this for an unconscious person, two responders are needed. It is not appropriate to do if you suspect that the person has a head, neck or spinal injury. Clothes DragUse with a conscious or unconscious person with a possible head, neck or spinal injury. Blanket DragUse with one responder for a conscious or unconscious person suspected of having a head, neck or spinal injury when equipment is limited. Ankle DragUse with one responder when a person is too large to carry or move in any other way. It is not appropriate to do if you suspect that the person has a head, neck or spinal injury.
TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
In any emergency situation, personal safety is the top priority. Protect yourself from disease transmission by using personal protective equipment, such as disposable gloves and breathing barriers, and following good personal hygiene practices, such as hand washing. Always check the scene for safety before you approach a person, and obtain consent from an adult person who is conscious and competent. If the person is an infant or child, get consent from the parent or guardian, if possible. If you must move a person, do so in a manner that is safe for you and will not cause the person any further harm. Answer participants questions. Read Chapter 4 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
LESSON
Before Giving Care
41
DRAFT
Skill Chart and Skill Assessment Tool

SKILL CHART: REMOVING GLOVES
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criterion below at the proficient level to be checked off for this skill. After giving care and making sure never to touch the bare skin with the outside of either glove: 1. Pinch the glove. Pinch the palm side of one glove near your wrist. Carefully pull the glove off so that it is inside out. 2. Slip two fingers under the glove. Hold the glove in the palm of the remaining gloved hand. Slip two fingers under the glove at the wrist of the remaining gloved hand. 3. Pull the glove off. Pull the glove until it comes off, inside out. The first glove should end up inside the glove you just removed. 4. Dispose of gloves and wash hands. After removing the gloves: Dispose of gloves in the appropriate biohazard container. Wash your hands thoroughly with soap and warm running water, if available. Otherwise, use an alcohol-based hand sanitizer to clean the hands if they are not visibly soiled.
SKILL ASSESSMENT TOOL: REMOVING GLOVES

Criteria Removes gloves Proficient Bare skin does not come into contact with outside surface of gloves Not Proficient Bare skin comes into contact with outside surface of glove(s)
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DRAFT
PART TWO
Assessment
Lesson 6 The Human Body, 44 Lesson 7 Checking an Unconscious Person, 48 Lesson 8 Checking a Conscious Person, 55
PART TWO
Assessment
43
LESSON
DRAFT
THE HUMAN BODY

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify various anatomical terms commonly used to refer to the body. Describe various body positions. Describe the major body cavities. Identify the eight body systems and the major structures in each system. Give examples of how body systems work together.

To complete this lesson and meet the lesson objectives, you must: Discuss the topics of anatomical terms, body cavities, body systems and the interrelationships among body systems. Conduct the activities related to the major body systems and situations reecting the interrelationship among body systems. Show the video segment: The Human Body.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor LCD projector, screen and computer Participants textbook Course Presentation: Part Two, The Human Body
TOPIC:
INTRODUCTION

Time: 2 minutes
It is not necessary to be an expert in human body structure and function to give effective care. Knowing some basic anatomical terms and understanding what the bodys structures are and how they work will help you more easily recognize and understand injuries and illnesses, and more accurately communicate with EMS personnel about a persons condition.
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DRAFT TOPIC:
ACTIVITY PRESENTATION: ANATOM ICAL TERMS
ANATOMICAL TERMS
Time: 14 minutes
Have participants break up into small groups and review the terms for directions and locations including anterior/posterior, superior/inferior, frontal or coronal plane, sagittal or lateral plane, transverse or axial plane, medial/lateral, proximal/distal, superficial/deep, internal/external and right/left. Ask each group to select a body part and describe its location using the appropriate anatomical term.
Instructors Note: Responses will vary based on the body part selected but examples could include: Shoulders are superior to the hips. Spine is posterior to the sternum. Head is proximal to the chest. Knees are distal to the abdomen. Nose is external but lungs are internal.
DISCUSSION PRESENTATION: ANATOM ICAL TERMS

In addition to knowing anatomical terms for locations on the body, there are terms that are helpful to know for movement. Flexion is used to describe a flexing or bending movement, such as bending at the knees or making a fist. Extension is the opposite of flexion; it is a straightening movement. You may also have to describe a persons position to the Emergency Medical Dispatcher (EMD) or other personnel. Anatomical position is the basis for all medical terms that refer to the body. The person stands with the body erect and arms down at the sides, palms facing forward. Supine position refers to the person lying face-up on his or her back. Prone position refers to the person lying face-down on his or her stomach. Right and left lateral recumbent position refers to the person lying on his or her right or left side. Fowlers position refers to the person lying on his or her back with the upper body elevated at a 45 to 60 angle. A body cavity is a hollow space in the body containing organs. There are five major body cavities: Cranial cavity, located in the head. It contains the brain and is protected by the skull. Spinal cavity, extends from the bottom of the skull to the lower back. It contains the spinal cord and is protected by the bones of the spine (vertebrae) and contains the spinal cord. Thoracic cavity (chest cavity), located in the trunk between the diaphragm and the neck. It contains the heart and lungs and is protected by the rib cage, sternum and the upper spine. Abdominal cavity, located in the trunk below the ribs, between the diaphragm and the pelvis. It contains the organs of digestion and excretion, including the liver, gallbladder, spleen, pancreas, kidneys, stomach and intestines. Pelvic cavity, located in the pelvis, the lowest part of the trunk. It contains the bladder, rectum and internal female reproductive organs. It is protected by the pelvic bones and the lower spine.
LESSON
The Human Body
45
DRAFT TOPIC:
VIDEO PRESENTATION: THE HUMAN BODY DISCUSSION PRESENTATION: BODY SYSTEMS

BODY SYSTEMS
Show the video segment: The Human Body (15:16).
Time: 25 minutes
The human body performs many complex functions, each of which helps us live. The human body is made up of billions of different types of cells that contribute in special ways to keep the body functioning normally. Similar cells form together into tissues that in turn form together into organs. Vital organs, such as the brain, heart and lungs, are organs whose functions are essential for life. All body systems must work well together for the body to work properly. Have participants read Scenario 1. Tell participants to consider which body cavities, organs and body systems might be involved or affected in the situation described.
ACTIVITY PRESENTATION: BODY SYSTEMS
Instructors Note: If you are using the presentation slides, show scenario 1 on the monitor for the participants to read. If you are not using the presentation slides, read scenario 1 to the participants, write the scenario on the chalkboard or newsprint or supply the participants with a written handout of the scenario. Scenario 1 You are at a local shopping mall where an older woman has fallen after attempting to get off an escalator. Bystanders report that she fell approximately three steps from the bottom of the escalator. She is lying in the left lateral recumbent position. The right side of her face is bruised, and there is a small laceration over her right cheek that is oozing blood. She is complaining that her right hip and right side hurt and that she bumped her head when she fell to the ground. Responses could include Cranial cavity due to bruising of the face and the report that the woman bumped her head on falling and thoracic and/or abdominal cavity based on the womans complaint that her right side hurts. Involvement of several body organs and systems, such as the brain and nervous system (due to bumping the head); lungs and respiratory system or abdominal organs, such as the liver, gallbladder and the digestive system (due to pain on the right side); possibly the kidneys and the urinary system (due to pain on the right side, which might include the lumbar area); blood vessels and circulatory system (due to bruising); facial bones and the skeletal system (due to facial bruising and injury, reported bump to the head and right hip pain); and the skin and integumentary system (due to the laceration on the cheek).
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DRAFT TOPIC:
INTERRELATIONSHIPS AMONG BODY SYSTEMS
Time: 2 minutes
DISCUSSION PRESENTATION: INTERRELATIONSHIPS AMONG BODY SYSTEMS
Each body system plays a vital role in survival: Body systems work together to help the body maintain a constant healthy state. Body systems depend on each other for survival. The impact of an injury or an illness is rarely restricted to one body system. The condition that results from progressive failure of body systems is called shock, which will be covered more fully in Chapter 9.
TOPIC:
CLOSING
Time: 2 minutes
DISCUSSION
By having a fundamental understanding of body systems and how they function and interact, coupled with knowledge of basic anatomical terms, you will be more likely to accurately identify and describe injuries and illnesses. Each body system plays a vital role in survival. The body systems work together to help the body maintain a constant, healthy state. The basic care taught in this course is usually all you need to provide support to injured body systems until more advanced care is available. Answer participants questions. Read Chapter 5 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
LESSON
The Human Body
47
LESSON
DRAFT
CHECKING AN UNCONSCIOUS PERSON

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe how to check for life-threatening conditions in an adult, child and infant. After completing the skill session, participants should be able to: Demonstrate how to check an unconscious adult, child and infant.

To complete this lesson and meet the lesson objectives, you must: Remind participants of the CHECKCALLCARE emergency steps. Identify conditions that are life-threatening. Show the video segments, Checking an Unconscious Adult and Child, and Checking an Unconscious Infant. Discuss how to check a person for consciousness. Conduct the skill sessions for checking an injured or ill adult (appears to be unconscious) and checking an injured or ill child or infant (appears to be unconscious).

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Two, Checking an Unconscious Person LCD projector, screen and computer Skill Charts: Checking an Injured or Ill Adult (Appears to be Unconscious), Checking an Injured or Ill Child or Infant (Appears to be Unconscious) Skill Assessment Tools: Checking an Injured or Ill Adult (Appears to be Unconscious) Checking an Injured or Ill Child or Infant (Appears to be Unconscious) Nonlatex disposable gloves (multiple sizes) Blankets or mats Manikins (adult, child and/or infant; one for every 2 participants; optional) Breathing barriers Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION
Time: 2 minutes
Recognizing an emergency and following the emergency action steps: CHECKCALLCARE can help you make a difference and even save a life in an emergency. Your decision to act can have a significant impact on the persons chance for survival.
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DRAFT TOPIC:
CHECKING FOR LIFETHREATENING CONDITIONS

Time: 5 minutes
DISCUSSION
PRESENTATION: CHECKING FOR LIFETHREATENING CONDITIONS
After checking the scene, you should check the person first for life-threatening conditions. Life-threatening conditions include: Unconsciousness. Trouble breathing or breathing that is not normal. Absence of breathing. Severe bleeding. The actions you will take depend on the conditions you find.
TOPIC:
CHECKING FOR CONSCIOUSNESS
Time: 5 minutes
DISCUSSION PRESENTATION: CHECKING FOR CONSCIOUSNESS
First, determine if the person is conscious. Tap him or her on the shoulder and shout, Are you okay? Use the persons name if you know it. Speak loudly. For an infant, gently tap the infants shoulder or flick the bottom of the foot. Do not jostle or move the person. If the person is unconscious, the situation is urgent. Unconsciousness is always a life-threatening condition. Call 9-1-1 or the local emergency number immediately. If you are in a situation in which you are the only person other than the injured or ill person, you should determine whether to call first or care first: Call first, that is, call 9-1-1 or the local emergency number before giving care for: An unconscious adult or adolescent age 12 or older. A witnessed sudden collapse of a child (1 to 12 years of age) or infant (<1 year of age). An unconscious child or infant known to have heart (cardiac) problems. Care first, that is, give 2 minutes of care and then call 9-1-1 or the local emergency number for: An unconscious person younger than 12 years of age who you did not see collapse. Any person who had a drowning incident. Once you or someone else has called 9-1-1 or the local emergency number, check for other life-threatening conditions. You will learn more about what to do if you need to make the call yourself later in this lesson.
LESSON
Checking an Unconscious Person
49
DRAFT TOPIC:
CHECKING AN UNCONSCIOUS PERSON
Time: 25 minutes
VIDEO
Show the video segments: Checking an Unconscious Adult and Child (3:36) and Checking an Unconscious Infant (1:51).
PRESENTATION: CHECKING AN UNCONSCIOUS ADULT AND CHILD PRESENTATION: CHECKING AN UNCONSCIOUS INFANT
DISCUSSION
PRESENTATION: CHECKING AN UNCONSCIOUS PERSON
When an unconscious adult is not breathing, or has irregular, gasping or shallow breaths (agonal breathing), assume a cardiac emergency and start CPR immediately after quickly scanning for severe bleeding. Give 2 rescue breaths first in the case of a known drowning or respiratory emergency. Tilt the head back and lift the chin up to open the airway. Pinch the nose shut then make a complete seal over the persons mouth. Blow in for about 1 second to make the chest clearly rise. Give 2 rescue breaths, one after the other, allowing for the chest to clearly rise and then fall. If the chest does not clearly rise after the first rescue breath, re-tilt the head and give another rescue breath to ensure the airway is open. When an unconscious child or infant is not breathing, and you did not witness the sudden collapse of the child or infant, give 2 rescue breaths as described in the video. If, however, you witnessed the sudden collapse of a child, assume a cardiac emergency. Do not give 2 rescue breaths. Start CPR chest compressions immediately. Sometimes, you may need to remove food, liquid or other objects that are blocking the persons airway. This may prevent the chest from rising when you attempt rescue breaths in the situations described above. You will learn how to recognize an obstructed airway and give care to the person in Chapter 7 of the textbook. When giving rescue breaths, use CPR breathing barriers when available. However, do not delay giving rescue breaths while searching for one. Child and infant CPR breathing barriers are available and should be used when giving breaths to a child or infant. Ask the participants to take the participants textbook, nonlatex disposable gloves and a CPR breathing barrier to the practice area. Tell participants that they will be using the skill sheets in Chapter 5 of the textbook. Assign partners or ask the participants to find a partner. One participant acts as the responder and one as the injured person. Use three different scenarios, for example, an adult who is found unconscious and not breathing, a child who has had a drowning incident, and an infant who is found unconscious. Alternatively, break the participants into small groups, each with a manikin for use as the injured person. If manikins are not being used, remind participants that they should not make mouth-to-mouth contact or blow into their partners face, but instead say breath, breath to indicate two initial rescue breaths if needed (i.e., for the child). Guide the participants through each skill (checking an adult and checking a child or infant) starting with checking the scene and the person. Remind participants of the need to follow standard precautions. Give help when appropriate or when requested.
SKILL SESSION: CHECKING AN INJU RED OR ILL ADU LT (APPEARS TO BE U NCONSCIOUS), CHECKING AN INJU RED OR ILL CHILD OR INFANT (APPEARS TO BE U NCONSCIOUS)
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DRAFT
CHECKING AN UNCONSCIOUS PERSON Continued
Participants should simulate sending someone to call for help. When participants reach the point at which they should check for signs of life (movement or breathing), instruct the responders, The person is not breathing. They should then quickly scan for severe bleeding. After the participants are able to practice the skill correctly, have them change places and repeat the practice. Give feedback when appropriate or help when requested. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) as you watch them practice successfully. Answer participants questions.
TOPIC:
RECOVERY POSITION

Time: 5 minutes
DISCUSSION PRESENTATION: RECOVERY POSITION
Generally a person should not be moved from a face-up position, especially if there is a suspected spinal injury. If you must leave an unconscious, but normally breathing person alone to call 9-1-1 or the local emergency number, or you cannot maintain an open and clear airway because of fluids or vomit, carefully position the person in the modified High Arm In Endangered Spine (H.A.IN.E.S) recovery position. An infant can be placed in a modified H.A.IN.E.S recovery position as would be done for an older child. You can also hold an infant in a recovery position by: Carefully positioning the infant facedown along your forearm. Supporting the infants head and neck with your other hand while keeping the infants mouth and nose clear. Keeping the head and neck slightly lower than the chest.
Instructors Note: Refer participants to Chapter 5 of the textbook for step-by-step instructions for placing someone in a modied H.A.IN.E.S. recovery position.
TOPIC:
CLOSING

Time: 3 minutes
DISCUSSION
By following the emergency action steps: CHECKCALLCARE, you can ensure that the person receives the best possible care. Determine if the person has any life-threatening conditions, which include unconsciousness; trouble breathing or breathing that is not normal; absence of breathing; and severe bleeding. Call 9-1-1 or the local emergency number if a person appears to have any of these signals. Answer participants questions. Review Chapter 5, Checking a Conscious Person.
ACTIVITY ASSIGNMENT
LESSON
51
DRAFT
Skill Charts and Skill Assessment Tools

SKILL CHART: CHECKING AN INJURED OR ILL ADULT (APPEARS TO BE UNCONSCIOUS)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criterion below at the proficient level to be checked off for this skill. Tip: Use disposable gloves and other PPE. After checking the scene for safety, check the person. 1. Check for unconsciousness (tap on the shoulder and shout, Are you okay?). 2. Call 9-1-1. If no response, call 9-1-1 or the local emergency number. If an unconscious person is face-down, roll him or her face-up, keeping the head, neck and back in a straight line. 3. Open the airway Tilt head, lift chin. 4. Check for breathing (Check for no more than 10 seconds) Occasional gasps are not breathing. 5. Quickly scan for severe bleeding. What to do next: If there is no breathingPerform CPR or use an AED (if AED is immediately available). If breathingMaintain an open airway, and monitor breathing for any changes in condition.
SKILL ASSESSMENT TOOL: CHECKING AN INJURED OR ILL ADULT (APPEARS TO BE UNCONSCIOUS)

Criterion Open the airway Proficient Tilts head back so that jaw line is at an angle of 80 to 100 to the floor Not Proficient Tilts head back so that jaw line is at an angle less than 80 or greater than 100 to the floor
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DRAFT
SKILL CHART: CHECKING AN INJURED OR ILL CHILD OR INFANT (APPEARS TO BE UNCONSIOUS)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criterion below at the proficient level to be checked off for this skill. Tip: Use disposable gloves and other PPE. Get consent from a parent or guardian, if present. After checking the scene for safety, check the child or infant. 1. Check for consciousness (tap the shoulder and shout, Are you okay? For an infant, you may flick the bottom of the foot). 2. Call 9-1-1. If no response, call 9-1-1 or the local emergency number. If an unconscious infant is face-down, roll him or her face-up, supporting the head, neck and back in a straight line. If alone, give about 2 minutes of care, then call 9-1-1. If the child or infant responds, call 9-1-1 or the local emergency number for any life-threatening conditions and obtain consent to give CARE. CHECK the child from head to toe and ask questions to find out what happened. 3. Open the airway. Tilt head back slightly, lift chin. 4. Check for breathing. (Check for no more than 10 seconds) Occasional gasps are not breathing. Infants have periodic breathing, so changes in breathing pattern are normal for infants. 5. Give 2 rescue breaths. If no breathing, give 2 rescue breaths. Tilt the head back and lift the chin up. Child: pinch the nose shut, and then make a complete seal over the childs mouth. Infant: Make complete seal over infants mouth and nose. Blow in for about 1 second to make the chest clearly rise. Give rescue breaths, one after the other. Each breath should last about 1 second and make the chest clearly rise. Tips: If you witnessed the child or infant suddenly collapse, skip rescue breaths and start CPR. If the chest does not clearly rise after the rst rescue breath, re-tilt the head and give another rescue breath. 6. Quickly scan for severe bleeding.
What to do next: If the chest does not rise after retilting the headgive CARE for unconscious choking. If there is no breathingPerform CPR or use an AED (if AED is immediately available). If breathingMaintain an open airway. Monitor breathing and for any changes in condition.
LESSON
53
DRAFT
IF NO BREATHING, GIVE 2 RESCUE BREATHS.
Criterion Open the airway Proficient Tilts head back so that jaw line is at an angle of 80 to 100 to the floor for a child and at an angle of 75 to 95 to the floor for an infant. Not Proficient Tilts head back so that jaw line is at an angle less than 80 or greater than 100 to the floor for a child and at an angle less than 75 or greater than 95 to the floor.
Give rescue breaths (only if using manikin for skill).
Gives rescue breaths that make the chest clearly rise. Gives rescue breaths that last about 1 second.
Gives 2 rescue breaths that do not make the chest clearly rise. OR Gives 2 rescue breaths that last 2 or more seconds.
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LESSON
DRAFT 8
CHECKING A CONSCIOUS PERSON

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify and explain at least three questions they should ask the person or bystanders in an interview. Describe how to check for non-life-threatening conditions for an adult, child and infant.

To complete this lesson and meet the lesson objectives, you must: Give examples of questions participants can ask when checking a conscious person. Identify the two basics steps for checking a person who is conscious. Review special considerations related to checking children and infants and older adults.

Participants textbook Course Presentation: Part Two, Checking a Conscious Person LCD projector, screen and computer
TOPIC:
INTRODUCTION

Time: 5 minutes
If you determine that a person is conscious and alert, you will proceed differently. Start by introducing yourself and getting consent to give care.
TOPIC:
CHECKING AND CARING FOR A CONSCIOUS PERSON

Time: 25 minutes
DISCUSSION PRESENTATION: CHECKING AND CARING FOR A CONSCIOUS PERSON
Check the person for any life-threatening conditions, such as trouble breathing or breathing that is not normal and severe bleeding, and give care as needed. Once you have determined there are no immediate life-threatening conditions, begin to check for other conditions that may need care. Checking a conscious person with no immediate life-threatening conditions involves two basic steps: Interviewing the person and bystanders. Checking the person from head to toe. Interview the person and bystanders, asking simple questions to learn more about what happened and to learn about the persons condition.
LESSON
Checking a Conscious Person
55
DRAFT
CHECKING AND CARING FOR A CONSCIOUS PERSON Continued
After asking the persons name, ask the following questions: What happened? Do you feel pain or discomfort anywhere? Do you have any allergies? Do you have any medications or are you taking any medication? If the person feels pain, ask the person: Can you describe the pain and where it is? What were you doing when you started experiencing pain? Can you rate the pain on a scale of 110 (1 being mild and 10 being severe)? If the person is unable to give you any information, ask family members, friends or bystanders. Write down the information you learn during the interview and provide it to EMS personnel. After interviewing the person, thoroughly check the person from head to toe: Do not move any areas where there is pain or discomfort, or if you suspect a head, neck or spinal injury. Check the persons head by examining the scalp, face, ears, mouth and nose. Look for cuts, bruises, bumps or depressions. Watch for changes in consciousness. Notice if the person is drowsy or confused or is not alert. Look for changes in the persons breathing. Notice how the skin looks and feels. Look over the body. Ask again about any areas that hurt; ask the person to move each part of the body that does not hurt. Ask the person to gently move his or her head from side to side. Check the shoulders by asking the person to shrug them. Check the chest and abdomen by asking the person to take a deep breath. Ask the person to move his or her fingers, hands and arms, and then the toes, legs and hips in the same way. Watch the persons face and listen for signals of discomfort or pain as you check for injuries. Look for a medical identification (ID) tag, bracelet or necklace on the persons wrist, neck or ankle.
CARE FOR A CONSCIOUS PERSON

DISCUSSION PRESENTATION: CARE FOR A CONSCIOUS PERSON
Once you complete the head-to-toe examination, if the person can move without pain and there are no other signals of injury or illness, have him or her attempt to rest in comfortable position. When the person feels ready, help him or her stand up. If you find signals of injury or illness, give care as needed and determine whether to call 9-1-1 or the local emergency number. While waiting for EMS to arrive: Do no further harm. Monitor the persons level of consciousness and breathing. A change in the persons condition may be a signal of a more serious injury or illness. A condition that may not appear serious at first may become serious over time. Help the person rest in the most comfortable position. Keep the person from getting chilled or overheated. Comfort and reassure the person, but do not provide false hope. Give any specific care as needed.
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DRAFT
CHECK FOR SHOCK
DISCUSSION PRESENTATION: CHECK FOR SHOCK

When someone becomes suddenly ill or is injured, normal body functions may be interrupted. In cases of minor injury or illness, the interruption is brief and the body is able to compensate quickly. With more severe injuries or illness, however, the body is unable to meet its demand for oxygen. The condition in which the body fails to circulate oxygen-rich blood to all the parts of the body is known as shock. If left untreated, shock can lead to death. Always look for the signals of shock whenever you are giving care which include: Restlessness or irritability. Altered level of consciousness. Nausea or vomiting. Pale, ashen or grayish, cool, moist skin. Rapid breathing. Excessive thirst. Be aware that the early signals of shock may not be present in young children and infants. However, because children are smaller than adults, they are more susceptible to shock.
Instructors Note: Shock is dened as inadequate tissue perfusion. Tell participants that they will learn more about how to recognize and treat a person for shock in Chapter 9 of the textbook.
TOPIC:
SPECIAL CONSIDERATIONS
Time: 10 minutes
CHECKING CHILDREN AND INFANTS

DISCUSSION PRESENTATION: CHECKING CHILDREN AND INFANTS

Children (age 112) and infants (<1 year of age) receive care that is slightly different from that given to adults. Checking a child or infant for life-threatening conditions follows the same steps as for an adult. Obtain consent from a parent or guardian if present and ask the parent or guardian to help calm the child. Communicate clearly with the parent or guardian and child. Explain what you are going to do. Place yourself at eye level with the child and talk slowly and in a friendly manner. Ask simple questions the child can answer easily. When checking a child for non-life-threatening conditions, observe the child before touching him or her. All signals may change as soon as you touch the child because he or she may become anxious or upset. When beginning the physical examination, begin at the toes instead of the head to allow the child to get used to the process as well as see what is going on.
CHECKING OLDER ADULTS

DISCUSSION PRESENTATION: CHECKING OLDER ADULTS

When checking older adults, attempt to learn the persons name and use it when you speak to him or her. Place yourself at the persons eye level and speak slowly and clearly, and look at the persons face while you talk.
LESSON
57
DRAFT
CHECKING OLDER ADULTS Continued

If the person is truly confused, try to find out if the confusion is the result of the injury or a condition he or she already has. Try to find out what medications the person is taking and if he or she has any medical conditions so that you can tell EMS personnel. Look for a medical ID bracelet or necklace. Be aware that an older adult may minimize any signals of injury or illness for fear of losing his or her independence or being placed in a nursing home.
TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
By following the emergency action steps: CHECKCALLCARE, you can ensure that the person receives the best possible care. If the person is conscious, interview the person and any bystanders to find out what happened. Always introduce yourself and obtain consent before giving care. Perform a head-to-toe examination (toe-to-head for a child or infant) to find and care for any injuries or signals of illness. If you do not give care, these conditions could become life threatening. Answer participants questions. Read Chapter 6 and answer the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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DRAFT
PART THREE
Life-Threatening Emergencies
Lesson 9: Cardiac Emergencies, 60 Lesson 10: CPRAdult, 65 Lesson 11: CPRChild, 70 Lesson 12: CPRInfant, 75 Lesson 13: AEDAdult, 80 Lesson 14: Adult AED Skill Practice and Scenarios, 86 Lesson 15: AEDChild and Infant, 94 Lesson 16: Child AED Skill Practice and Scenarios, 99 Lesson 17: Breathing Emergencies, 108 Lesson 18: Conscious ChokingAdult and Child, 116 Lesson 19: Conscious ChokingInfant, 121 Lesson 20: Unconscious ChokingAdult and Child, 125 Lesson 21: Unconscious ChokingInfant, 130 Lesson 22: Bleeding, 135 Lesson 23: Internal Bleeding/Shock, 141 Lesson 24: Putting It All Together I (Introduction, Assessment, and Life-Threatening Emergencies), 145
PART THREE
Life-Threatening Emergencies
59
LESSON
DRAFT
CARDIAC EMERGENCIES
LESSON OBJECTIVES
After completing the lesson, participants should be able to: List the signals of a heart attack for both men and women. Describe the care for a person having a heart attack. Identify the links in the Cardiac Chain of Survival.

To complete this lesson and meet the lesson objectives, you must: Discuss the major types of cardiac emergencies. Conduct the activity related to the signals of a heart attack. Show the video, Recognizing and Caring for Cardiac Emergencies. Describe the care for a person experiencing a heart attack and cardiac arrest, including the role of CPR and AED. List the links in the Cardiac Chain of Survival.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor LCD projector, screen and computer Participants textbook Course Presentation: Part Three, Cardiac Emergencies Newsprint or chalkboard Markers or chalk
TOPIC:
INTRODUCTION

Time: 7 minutes
Two of the most common cardiac emergencies are heart attack and cardiac arrest. Cardiovascular disease is the leading cause of cardiac emergencies. Cardiovascular disease is an abnormal condition that affects the heart and blood vessels. It remains the number one killer in the United States and is a major cause of disability. Cardiovascular disease causes coronary heart disease (CHD), also known as coronary artery disease. CHD occurs when the coronary arteries that supply blood to the heart muscle harden and narrow in a process called atherosclerosis. The damage occurs gradually, as cholesterol and fatty deposits called plaque build up on the inner artery walls. As this build-up worsens, the arteries become narrower. This reduces the amount of blood that can flow through the arteries and prevents the heart from getting the blood and oxygen it needs. If the heart does not get blood containing oxygen, it will not work properly.
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DRAFT TOPIC:
HEART ATTACK

Time: 25 minutes
DISCUSSION PRESENTATION: HEART ATTACK
A heart attack results when the blood and oxygen supply to the heart is reduced, usually from coronary heart disease. Many people having a heart attack delay seeking care and often mistake the signals for indigestion. By knowing and recognizing the signals of heart attack, you can ensure a person gets prompt care.
SIGNALS OF A HEART ATTACK

ACTIVITY

Ask participants to list the signals of a heart attack. Record the participants responses on newsprint or chalkboard. Ask participants what they would do to care for someone who might be having a heart attack.
VIDEO
Show the video segment, Recognizing and Caring for Cardiac Emergencies. (2:21). Instructors Note: When showing the video, stop the video at the end of the indoor stories portion of the segment (approximately 2:21 minutes), just before the outside scenario, which focuses on cardiac arrest and the cardiac chain of survival, begins.
PRESENTATION: RECOGNIZING AND CARING FOR CARDIAC EM ERGENCIES

ACTIVITY
Ask the participants if there are any other signals of heart attack that they would add to their original list after seeing this video.
Instructors Note: Participants responses should include the following signals: Persistent chest pain, discomfort or pressure that lasts longer than 3 to 5 minutes or goes away and comes back Discomfort in other areas of the upper body along with chest pain Shortness of breath or trouble breathing Nausea or vomiting Dizziness, light-headedness or fainting Pale or ashen skin Sweating Denial
DISCUSSION PRESENTATION: SIGNALS OF A HEART ATTACK
Instructors Note: When completing this discussion, compare the participants responses recorded earlier about the signals of a heart attack with those presented in the discussion. The most prominent signal of a heart attack is persistent chest pain, discomfort or pressure that lasts longer than 3 to 5 minutes or goes away and comes back. Heart attack pain: Can range from discomfort to an unbearable crushing sensation in the chest. May be described by the person as pressure, squeezing, tightness, aching or heaviness in the chest. May start slowly as mild pain or discomfort. Is often felt in the center of the chest behind the sternum. Becomes constant and is usually not relieved by resting, changing position or taking medication. Some individuals show NO signals at all.
LESSON
Cardiac Emergencies
61
DRAFT
SIGNALS OF A HEART ATTACK Continued
Other signals include discomfort, pain or pressure that is felt in or spreads to the shoulder, arm, neck, jaw, stomach or back; trouble breathing and pale, ashen skin, particularly around the face. The skin may also be moist from perspiration. As with men, a womans most common heart attack signal is chest pain, discomfort or pressure; but women are somewhat more likely to experience some of the other warning signals, particularly: Shortness of breath. Nausea or vomiting. Back or jaw pain. Unexplained fatigue or malaise. Atypical chest pain such as sudden, sharp but short-lived pain outside of the breastbone.
CARE FOR A HEART ATTACK

DISCUSSION

PRESENTATION: CARE FOR A HEART ATTACK
The most important first aid measure is to be able to recognize the signals of a heart attack and take action. A person having a heart attack may deny the seriousness of the signals he or she is experiencing. Do not let this denial influence you. If you think that the person might be having a heart attack, you must act: Call 9-1-1 or the local emergency number immediately. Have the person stop what he or she is doing and rest comfortably. Do not let the person walk around, for example. Monitor the person closely until EMS personnel arrive. Note any changes in the persons appearance or behavior. Be prepared to perform CPR or use an AED if the person loses consciousness and stops breathing. Ask the person if he or she has a history of heart disease. Some people who have heart disease take prescribed medications for chest pain. You can help by getting the medication for the person and assisting him or her to take it. Offer aspirin, if medically appropriate, in the form of two chewable (81 mg each) baby aspirins, or one 5-grain (325 mg) adult aspirin tablet with a small amount of water if the person is able to take medication by mouth and answers No to the following questions: Is the person allergic to aspirin? Does the person have a stomach ulcer or stomach disease? Is the person taking any blood thinners? Has the person been told by a doctor not to take aspirin? Keep a calm and reassuring manner. Comforting the person helps reduce anxiety and eases some of the discomfort. Loosen any restrictive or uncomfortable clothing the person is wearing. Talk to bystanders and, if possible, interview the person to get more information. Do not try to drive the person to the hospital yourself. The persons condition could quickly deteriorate while you are en route to the hospital.
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DRAFT TOPIC:
ANGINA PECTORIS

Time: 2 minutes
DISCUSSION
PRESENTATION: ANGINA PECTORIS
Angina pectoris is chest pain that comes and goes at different times (intermediate chest pain or pressure). Often simply called angina, it develops when the heart needs more oxygen than it is getting due to a narrowing of the coronary arteries. When the coronary arteries are narrow and the heart needs more oxygen, heart muscle tissues may not get enough oxygen. Pain associated with angina seldom lasts longer than 3 to 5 minutes. A person who knows that he or she has a history of angina may have prescribed medication, such as nitroglycerin, to temporarily widen the arteries and therefore help relieve the pain. Most people with angina are advised by their doctor to take three nitroglycerin doses over a 10-minute period if they are experiencing pain or discomfort, however some doctors prescribe nitroglycerin differently. Since areas of narrowing can be the focus for clot formation and heart attack, if a persons typical pain of angina lasts longer than usual, 9-1-1 or the local emergency number should be called. It may be that the angina has progressed to a heart attack.
TOPIC:
CARDIAC ARREST

Time: 8 minutes
DISCUSSION
PRESENTATION: CARDIAC ARREST
Cardiac arrest occurs when the heart stops beating or beats too ineffectively and blood cannot be circulated to the brain and other vital organs. It is a life-threatening emergency because without oxygen, brain damage can begin in 4 to 6 minutes, with the damage becoming irreversible after about 10 minutes. Cardiovascular disease is the most common cause of cardiac arrest. Other causes include drowning, choking, and drug abuse, severe chest injuries, severe blood loss, electrocution, stroke or other types of brain damage. Cardiac arrest is fatal without emergency care and can happen suddenly without any of the warning signals usually seen in a heart attack. A person in cardiac arrest will be unconscious and will not be breathing. Remember, if you detect agonal breathing (an irregular gasping or shallow breath), you should care for the person as if they are not breathing at all. In addition, the persons skin may be pale, ashen or bluish, particularly around the face. The skin also may be moist from perspiration.
CARDIAC CHAIN OF SURVIVAL

VIDEO PRESENTATION: RECOGNIZING CARDIAC EM ERGENCIES DISCUSSION PRESENTATION: CARDIAC CHAIN OF SURVIVAL
Show the video segment, Recognizing Cardiac Emergencies (2:04)
Instructors Note: When showing the video, start the video at the beginning of the outdoor scenario, which focuses on a person in cardiac arrest and following the cardiac chain of survival (approximately 2:22 minutes to the end of the video).

A person has the greatest chance for survival when the four links of the Cardiac Chain of Survival happen as rapidly as possible. Each link in the chain depends on, and is connected to, the other links.
LESSON
Cardiac Emergencies
63
DRAFT
CARDIAC CHAIN OF SURVIVAL Continued

Each minute that CPR and defibrillation are delayed reduces the chance of survival by about 10 percent. As a lay responder, you are the first link in the Cardiac Chain of Survival. By acting quickly, you can make a positive difference for someone experiencing a cardiac emergency.
TOPIC:
CLOSING

Time: 3 minutes
DISCUSSION
Heart attack and cardiac arrest are the two most common cardiac emergencies. The primary signal of a heart attack is persistent chest pain, discomfort or pressure. Learning to recognize the signals of a heart attack and responding immediately can reduce the risk of cardiac arrest occurring. A person in cardiac arrest shows no signs of life. If a person experiences cardiac arrest, the greatest chance of survival occurs when the four links of the Cardiac Chain of Survivalearly recognition and early access, early CPR, early defibrillation and early advanced medical carehappen as rapidly as possible. Answer participants questions. Review Chapter 6, CPR for an Adult. Review the skill sheet: CPRAdult (No Breathing) in Chapter 6 of the textbook.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 10
CPRADULT
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe the role of CPR in cardiac arrest. After completing the skill session, participants should be able to: Demonstrate how to perform CPR for an adult.

To complete this lesson and meet the lesson objectives, you must: Review the reasons for performing CPR. Show the video segment, CPRAdult and Child. Show the video segment, Hands-Only CPR (OPTIONAL). Conduct the skill session for performing CPR for an adult.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor LCD projector, screen and computer Participants textbook Course Presentation: Part Three, CPRAdult Skill Chart: CPRAdult (No Breathing) Skill Assessment Tool: CPRAdult (No Breathing) Nonlatex disposable gloves (multiple sizes) CPR breathing barriers (face shields or resuscitation masks, one for each participant) Adult manikins (one for every two participants) Decontamination supplies Blankets or mats Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 15 minutes
A person in cardiac arrest will be unconscious and will not be breathing (Remember: agonal breaths do not count as breathing). The cells of the brain and other vital organs will continue to live for a short period (approximately 46 minutes) until oxygen is depleted. However, without immediate intervention, a person will not survive. CPR is a combination of chest compressions and rescue breaths, which when performed together, artificially take over the functions of the lungs and heart, increasing the persons chance for survival by keeping the brain supplied with oxygen until advanced medical care can be provided.
LESSON
10
CPRAdult
65
DRAFT
INTRODUCTION Continued
Follow the emergency action steps: CHECKCALLCARE to determine if an unconscious adult needs CPR. CHECK the scene and the injured or ill person. If the person is unconscious, CALL 9-1-1 or the local emergency number or send someone to call. CHECK for breathing for no more than 10 seconds. Quickly CHECK for severe bleeding. If the person is not breathing, give CARE by beginning CPR with 30 chest compressions followed by 2 rescue breaths. If necessary, move the person so he or she is lying on his or her back on a firm, flat surface before beginning CPR. CPR is not effective if the person is on a soft surface, such as a bed or sofa, or is sitting up.
VIDEO
Show the video segment, CPRAdult and Child (0:00 to 6:36). Instructors Note: When showing the video, stop the video at the end of the adult portion of the segment (approximately 6:36 minutes), just before CPRChild begins.
PRESENTATION: CPRADULT AND CHILD
TOPIC:
CPRADULT
Time: 24 minutes
SKILL SESSION: CPRADU LT
Ask the participants to take the textbook, nonlatex disposable gloves and breathing barriers to the practice area. Tell participants that they will be using the skill sheet in Chapter 6 of the textbook. Assign partners or ask the participants to find a partner. One participant acts as the responder and the other observes. Have the participant acting as the responder from each pair kneel beside the manikin and clean or prepare the manikin for use. Guide the participants through the skill, beginning by checking the person. Give participants the appropriate prompt at each CHECK step and observe for the correct response.
Instructors Note: The compression rate during CPR is at least 100 compressions per minute. Use some form of an audio timing prompt, such as counting out loud (for example, 1 and 2 and 3 and 4 and 5 and ) to help participants give 30 compressions within 18 seconds. Give feedback when appropriate or help when requested. After the participants are able to practice the skill correctly, have them change places. Repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
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DRAFT TOPIC:
CONTINUOUS CHEST COMPRESSIONS

Show the video segment, Hands-Only CPR (1:42) (OPTIONAL).
Time: 3 minutes
VIDEO
PRESENTATION: HANDS-ONLY CPR

DISCUSSION
If you are unable or unwilling for any reason to perform full CPR (with rescue breaths), give continuous chest compressions after calling 9-1-1 or the local emergency number. Continue giving chest compressions until you notice an obvious sign of life, such as breathing, an AED is ready to use, another trained responder or EMS personnel arrive and take over, you are too exhausted to continue or the scene becomes unsafe.
TOPIC:
CLOSING
Time: 3 minutes
DISCUSSION
When performing CPR on an adult, give 30 chest compressions to a depth of at least 2 inches, at a rate of at least 100 compressions per minute followed by 2 rescue breaths. Do not stop CPR unless: The adult shows obvious signs of life, such as breathing. An AED becomes available and is ready to use. Another trained rescuer or EMS personnel arrive and take over. You are too exhausted to continue. The scene becomes unsafe. If at any time the adult begins to breathe, stop CPR, keep the airway open and monitor breathing and any changes in the adults condition closely until EMS personnel take over. Answer participants questions. Review the skill sheet, CPRChild (No Breathing) in Chapter 6 of the textbook.
ACTIVITY ASSIGNMENT
LESSON
10
CPRAdult
67
DRAFT

SKILL CHART: CPRADULT (NO BREATHING)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill person: 1. Give 30 chest compressions. Push hard, push fast in the center of the chest. Compress the chest at least 2 inches deep for an adult. Compress at a rate of at least 100 times per minute. Tip: The person must be on a firm, flat surface. 2. Give 2 rescue breaths. Tilt the head back and lift the chin up. Pinch the nose shut then make a complete seal over the persons mouth. Blow in for about 1 second to make the chest clearly rise. Give rescue breaths, one after the other. If the chest does not rise with the first rescue breath, retilt the head and give another rescue breath. 3. Do not stop. Continue cycles of CPR. Do not stop except in one of these situations: You find an obvious sign of life, such as breathing. An AED is ready to use. Another trained responder or EMS personnel take over. You are too exhausted to continue. The scene becomes unsafe. Tip: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. What to do next: Use an AED as soon as one is available. If breaths do not make the chest riseGive CARE for unconscious choking.
SKILL ASSESSMENT TOOL: CPRADULT (NO BREATHING)

Criteria Compress chest at least 2 inches deep for an adult. Let chest rise completely before pushing down again. Proficient Compresses chest straight down at least 2 inches for 2430 times per 30 compressions Compresses and fully releases chest without pausing or taking hands off chest for 2430 times per 30 compressions Compresses chest 2436 times in about 18 seconds Not Proficient Compresses chest less than 2 inches for 7 or more times per 30 compressions Pauses or fails to fully release chest while compressing for 7 or more times per 30 compressions Compresses chest less than 24 or more than 36 times in about 18 seconds
Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds).
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SKILL ASSESSMENT TOOL: CPRADULT (NO BREATHING) Continued
Give rescue breaths. Gives 2 rescue breaths that make the chest clearly rise Gives rescue breaths that last about 1 second Return to compressions. Gives rescue breaths and returns to chest compressions within 36 seconds Gives 2 rescue breaths that do not make the chest clearly rise Gives 2 rescue breaths that last 2 or more seconds Gives rescue breaths and returns to chest compressions but takes 7 or more seconds
LESSON
10
CPRAdult
69
LESSON
11
DRAFT
CPRCHILD
LESSON OBJECTIVES
After completing the skill session, participants should be able to: Demonstrate how to perform CPR for a child.

To complete this lesson and meet the lesson objectives, you must: Review the reasons for performing CPR for a child. Show the video segment, CPRAdult and Child. Conduct the skill session for performing CPR for a child.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor LCD projector, screen and computer Participants textbook Course Presentation: Part Three, CPRChild Skill Chart: CPRChild (No Breathing) Skill Assessment Tool: CPRChild (No Breathing) Nonlatex disposable gloves (multiple sizes) CPR breathing barriers (face shields or resuscitation masks, one for each participant) Child manikins (one for every two participants) Decontamination supplies Blankets or mats Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 10 minutes
Unlike adults, children do not often initially suffer a cardiac emergency. In general, a child suffers a respiratory emergency and then a cardiac emergency develops. Most cardiac arrests in children are not sudden. The most common causes of cardiac arrest in children are airway and breathing problems (such as airway obstruction, smoke inhalation, asthma attack and severe epiglottitis) and trauma (such as an automobile crash or a hard blow to the chest, drowning, electrocution, poisoning, firearm injuries and falls). Occasionally the source of cardiac arrest in children is congenital in nature (i.e., resulting from a condition that has existed since birth).
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As with an adult, use the emergency action steps: CHECKCALLCARE to determine if you need to perform CPR on a child as follows: CHECK the scene and the injured or ill child. If the child is unconscious, CALL 9-1-1 or the local emergency number (if you are alone and did not witness a collapse, wait to call until you have first given two minutes of care) or send someone to call. CHECK for breathing for no more than 10 seconds. If a child is not breathing, and a sudden collapse was not witnessed, give 2 rescue breaths. Quickly CHECK for severe bleeding. If the child is not breathing (and the rescue breaths, if given, make the childs chest clearly rise), give CARE by beginning CPR with 30 chest compressions followed by 2 rescue breaths. If necessary, move the child so he or she is lying on his or her back on a firm, flat surface before beginning CPR. CPR is not effective if the child is on a soft surface, such as bed or sofa, or is sitting up. Because children have smaller bodies and faster breathing and heart rates, the CPR techniques you use will be slightly different than those used for an adult.
VIDEO PRESENTATION: CPRADULT AND CHILD
Show the video segment, CPRAdult and Child (1:10 minutes). Instructors Note: Begin the video segment at approximately 6:36 minutes to focus on CPR for the child.
TOPIC:
CPRCHILD
Time: 30 minutes
SKILL SESSION: CPRCHILD
Ask the participants to take the textbook, disposable gloves and breathing barriers to the practice area. Tell participants that they will be using the skill sheet in Chapter 6 of the textbook. Assign partners or ask the participants to find a partner. One participant acts as the responder while the other observes. Have the participant acting as the responder from each pair kneel beside the manikin and clean or prepare the manikin for use. Guide the participants through the skill, beginning by checking the person. Give participants the appropriate prompt at each CHECK step and observe for the correct response.
Instructors Note: The compression rate during CPR is at least 100 compressions per minute. Use some form of an audio timing prompt, such as counting out loud (for example, 1 and 2 and 3 and 4 and 5 and ) to help participants give 30 compressions within about 18 seconds. Give feedback when appropriate or help when requested. After the participants are able to practice the skill correctly, have them change places. Repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
|
LESSON
11
CPRChild
71
DRAFT TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
When performing CPR on a child, give 30 chest compressions to a depth of about 2 inches at a rate of about 100 compressions per minute followed by 2 rescue breaths. Do not stop CPR unless: The child shows obvious signs of life, such as breathing. An AED becomes available and is ready to use. Another trained rescuer or EMS personnel arrive and take over. You are too exhausted to continue. The scene becomes unsafe. If at any time the child begins to breathe, stop CPR, keep the airway open and monitor breathing and any changes in the childs condition closely until EMS personnel take over. Answer participants questions. Review the skill sheet, CPRInfant (No Breathing) in Chapter 6 of the textbook.
ACTIVITY ASSIGNMENT
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DRAFT

SKILL CHART: CPRCHILD (NO BREATHING)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill child: 1. Give 30 chest compressions. Push hard, push fast in the center of the chest. Compress the chest about 2 inches deep for a child. Compress at a rate of at least 100 times per minute. Tip: The child must be on a firm, flat surface. 2. Give 2 rescue breaths. Tilt the head back and lift the chin up. Pinch the nose shut then make a complete seal over the childs mouth. Blow in for about 1 second to make the chest clearly rise. Give rescue breaths, one after the other. If the chest does not rise with the first rescue breath, retilt the head and give another rescue breath. 3. Do not stop. Continue cycles of CPR. Do not stop except in one of these situations: You find an obvious sign of life such as breathing. An AED is ready to use. Another trained responder or EMS personnel take over. You are too exhausted to continue. The scene becomes unsafe. Tip: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. What to do next: Use an AED as soon as one is available. If breaths do not make the chest riseGive CARE for unconscious choking.
SKILL ASSESSMENT TOOL: CPRCHILD (NO BREATHING)

Criteria Compress chest about 2 inches deep for a child. Let chest rise completely before pushing down again. Proficient Compresses chest straight down at least 1 inches for 2430 times per 30 compressions Compresses and fully releases chest without pausing or taking hands off chest for 2430 times per 30 compressions Not Proficient Compresses chest less than 1 inches for 7 or more times per 30 compressions Pauses or fails to fully release chest while compressing for 7 or more times per 30 compressions
LESSON
11
CPRChild
73
DRAFT
SKILL ASSESSMENT TOOL: CPRCHILD (NO BREATHING) Continued
Criteria Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds). Give rescue breaths. Proficient Compresses chest 2436 times in about 18 seconds Gives rescue breaths that make the chest clearly rise Gives rescue breaths that last about 1 second Return to compressions. Gives rescue breaths and returns to chest compressions within 36 seconds Not Proficient Compresses chest less than 24 or more than 36 times in about 18 seconds Gives 2 rescue breaths that do not make the chest clearly rise Gives 2 rescue breaths that last 2 or more seconds Gives rescue breaths and returns to chest compressions but takes 7 or more seconds
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LESSON
DRAFT 12
CPRINFANT
LESSON OBJECTIVES
After completing the skill session, participants should be able to: Demonstrate how to perform CPR for an infant.

To complete this lesson and meet the lesson objectives, you must: Review the reasons for performing CPR for an infant. Show the video segment, CPRInfant. Conduct the skill session for performing CPR for an infant.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor LCD projector, screen and computer Participants textbook Course Presentation: Part Three, CPRInfant Skill Chart: CPRInfant (No Breathing) Skill Assessment Tool: CPRInfant (No Breathing) Nonlatex disposable gloves (multiple sizes) CPR breathing barriers (face shields or resuscitation masks, one for each participant) Infant manikins (one for every two participants) Decontamination supplies Blankets or mats Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 12 minutes
Unlike adults, infants do not often initially suffer a cardiac emergency. In general, an infant suffers a respiratory emergency, which then could develop into a cardiac emergency. Most cardiac arrests in infants are not sudden. The most common causes of cardiac arrest in infants are airway and breathing problems (such as airway obstruction, smoke inhalation, asthma attack and severe epiglottitis), and trauma (such as an automobile crash or a hard blow to the chest, drowning, electrocution, poisoning, firearm injuries and falls). Rarely, the source of cardiac arrest in infants is congenital in nature (i.e., resulting from a condition that has existed since birth).
LESSON
12
CPRInfant
75
DRAFT
As with an adult, use the emergency action steps: CHECKCALLCARE to determine if you need to perform CPR on an infant as follows: CHECK the scene and the injured or ill infant. If the infant is unconscious, CALL 9-1-1 or the local emergency number (if you are alone and did not witness a collapse, wait to call until you have first given two minutes of care) or send someone to call. CHECK for breathing for no more than 10 seconds. If the infant is not breathing, and the sudden collapse was not witnessed, give 2 rescue breaths. Quickly CHECK for severe bleeding. If the infant is not breathing (and the rescue breaths, if given, make the infants chest clearly rise), give CARE by beginning CPR with 30 chest compressions followed by 2 rescue breaths. If necessary, move the infant so he or she is lying on his or her back on a firm, flat surface before beginning CPR. CPR is not effective if the infant is on a soft surface, such as a bed or sofa, or is sitting up. Because infants have smaller bodies and faster breathing and heart rates, the CPR techniques you use will be slightly different than those used for an adult.
VIDEO PRESENTATION: CPRINFANT
Show the video segment, CPRInfant (6:51 minutes)
TOPIC:
CPRINFANT
Time: 30 minutes
SKILL SESSION: CPRINFANT
Ask the participants to take the textbook, nonlatex disposable gloves and breathing barriers to the practice area. Tell participants that they will be using the skill sheet in Chapter 6 of the textbook. Assign partners or ask the participants to find a partner. One participant acts as the responder while the other observes. Have the participant acting as the responder from each pair kneel beside the manikin and clean or prepare the manikin for use. Guide the participants through the skill, beginning with checking the person. Give participants the appropriate prompt at each CHECK step and observe for the correct response.
Instructors Note: The compression rate during CPR is at least 100 compressions per minute. Use some form of an audio timing prompt, such as counting out loud (for example, 1 and 2 and 3 and 4 and 5 and ) to help participants give 30 compressions within about 18 seconds. Give feedback when appropriate or help when requested. After the participants are able to practice the skill correctly, have them change places. Repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
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DRAFT TOPIC:
CLOSING

Time: 3 minutes
DISCUSSION
When performing CPR on an infant, use two to three fingers to compress the chest to a depth of about 1 inches while maintaining an open airway. Give 30 chest compressions at a rate of about 100 compressions per minute followed by 2 rescue breaths. Do not stop CPR unless: The infant shows obvious signs of life, such as breathing. An AED becomes available and is ready to use. Another trained rescuer or EMS personnel arrive and take over. You are too exhausted to continue. The scene becomes unsafe. If at any time the infant begins to breathe, stop CPR, keep the airway open and monitor breathing and any changes in the infants condition closely until EMS personnel take over. Answer participants questions. Review Chapter 6, Automated External Defibrillation. Review the skill sheet, AEDAdult or Child Older than 8 Years or Weighing More than 55 Pounds in Chapter 6 of the textbook.
ACTIVITY ASSIGNMENT
LESSON
12
CPRInfant
77
DRAFT

SKILL CHART: CPRINFANT (NO BREATHING)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill infant: 1. Give 30 chest compressions. Push hard, push fast in the center of the chest. Compress the chest about 1 inches deep. Compress at a rate of at least 100 times per minute. Let the chest rise completely before pushing down again. Tip: The infant must be on a firm, flat surface. 2. Give 2 rescue breaths. Tilt the head back and lift the chin up. Make a complete seal over the infants mouth and nose. Blow in for about 1 second to make the chest clearly rise. Give rescue breaths, one after the other. If chest does not rise with the first rescue breath, retilt the head and give another rescue breath. 3. Do not stop. Continue cycles of CPR. Do not stop except in one of these situations: You find an obvious sign of life, such as breathing. An AED is ready to use. Another trained responder or EMS personnel take over. You are too exhausted to continue. The scene becomes unsafe. Tip: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. What to do next: Use an AED as soon as one is available. If breaths do not make the chest riseGive CARE for unconscious choking.
SKILL ASSESSMENT TOOL: CPRINFANT (NO BREATHING)

Criteria Compress chest about 1 inches deep. Let the chest rise completely before pushing down again. Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds). Proficient Compresses chest straight down at least 1 inches for 2430 times per 30 compressions Compresses and releases chest without pausing for 2430 times per 30 compressions Compresses chest 2436 times in about 18 seconds Not Proficient Compresses chest less than 1 inches for 7 or more times per 30 compressions Pauses while compressing or releasing for 7 or more times per 30 compressions Compresses chest less than 24 or more than 36 times in about 18 seconds
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SKILL ASSESSMENT TOOL: CPRINFANT (NO BREATHING) Continued
Give rescue breaths. Gives rescue breaths that make the chest clearly rise Gives rescue breaths that last about 1 second Return to compressions. Gives rescue breaths and returns to chest compressions within 36 seconds Gives 2 rescue breaths that do not make the chest clearly rise Gives 2 rescue breaths that last 2 or more seconds Gives rescue breaths and returns to chest compressions but takes 7 or more seconds
LESSON
12
CPRInfant
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LESSON
13
DRAFT
AEDADULT
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe debrillation and how it works. Describe the general steps for the use of an automated external debrillator (AED). List the precautions for the use of an AED. After completing the skill session, participants should be able to: Demonstrate how to use an AED to care for an adult in cardiac arrest.

To complete this lesson and meet the lesson objectives, you must: Dene debrillation. Explain how debrillation works. Conduct the activity related to the cardiac chain of survival. Show the video segment, Using an AED. Conduct the skill session for using an AED for an adult. List the safety precautions necessary when using an AED.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor LCD projector, screen and computer Participants textbook Course Presentation: Part Three, AEDAdult Skill Chart: AEDAdult or Child Older than 8 Years or Weighing More than 55 Pounds Skill Assessment Tool: AEDAdult or Child Older than 8 Years or Weighing More than 55 Pounds AED training devices and pads (one for every two participants) Nonlatex disposable gloves (multiple sizes) CPR breathing barriers (face shields or resuscitation masks, one for each participant) Adult manikins (one for every two participants) Decontamination supplies Blankets or mats Newsprint or chalkboard Markers or chalk Participant Progress Log (Appendix E or Instructors Corner)
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DRAFT TOPIC:
INTRODUCTION

Time: 3 minutes
Most people in sudden cardiac arrest need an electrical shock called defibrillation. Defibrillation is an electrical shock that interrupts the hearts chaotic electrical activity during sudden cardiac arrest. Each minute that defibrillation is delayed reduces the chance of survival by about 10 percent. The sooner the shock is administered, the greater the likelihood of the persons survival when an AED is used in conjunction with CPR.
TOPIC:
AUTOMATED EXTERNAL DEFIBRILLATION

Time: 15 minutes
DISCUSSION PRESENTATION: AUTOMATED EXTERNAL DEFIBRILLATION
Any damage to the heart from disease or injury can disrupt the hearts electrical system, resulting in an abnormal heart rhythm that can stop circulation. The two most common abnormal rhythms leading to cardiac arrest are ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach). V-fib is a state of totally disorganized electrical activity in the heart, resulting in fibrillation, or quivering, of the ventricles. In V-fib, electrical impulses fire at random, creating chaos and preventing the heart from pumping and circulating blood. V-tach refers to a very rapid contraction of the ventricles. Electrical activity is present and results in a regular rhythm, but the rate is often so fast that the heart is unable to pump blood properly. With either abnormal rhythm, the person may collapse, become unconscious and stop breathing. In many cases, V-fib and V-tach rhythms can be corrected by early defibrillation using an AED, which is the third link in the Cardiac Chain of Survival. An AED is a device that analyzes the hearts rhythm and if necessary, tells you to deliver a shock to the person with sudden cardiac arrest. Using an AED disrupts the electrical activity of V-fib and V-tach long enough to allow the heart to spontaneously develop an effective rhythm on its own. With cardiac arrest, an AED should be used as soon as it is available and safe to do so. Call 9-1-1 or the local emergency number. CPR in progress is stopped only when the AED is ready to use. Have participants consider the following scenario: You are at class and an instructor collapses from cardiac arrest. Ask participants, What has to happen to improve this persons chance of survival? Have participants provide responses, writing them on newsprint or chalkboard for all to see.
ACTIVITY PRESENTATION: AUTOMATED EXTERNAL DEFIBRILLATION
Instructors Note: When recording the participants responses, do not be concerned about putting them in the correct order until each link of the Cardiac Chain of Survival and its importance has been identied. Reinforce participants responses as well as each link in the Cardiac Chain of Survival.
LESSON
13
AEDAdult
81
DRAFT
AUTOMATED EXTERNAL DEFIBRILLATION Continued
VIDEO PRESENTATION: USING AN AED
Show the video segment, Using an AED (4:45 minutes).
TOPIC:
USING AN AEDADULT
Time: 17 minutes
SKILL SESSION: AEDADU LT
Ask the participants to take the textbook, nonlatex disposable gloves and breathing barriers to the practice area. Tell participants that they will be using the skill sheet in Chapter 6 of the textbook. Using nonlatex disposable gloves and the AED training device on an adult manikin, guide the participants as a group through the steps for using an AED. Assign partners or ask the participants to find a partner. One participant acts as the responder while the other observes. Have the participant acting as the responder from each pair kneel beside the manikin and clean or prepare the manikin for use and then practice using the AED training device. Give feedback when appropriate or help when requested. After the participants are able to practice the skill correctly, have them change places. Repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
TOPIC:
SAFETY PRECAUTIONS WHEN USING AN AED

Time: 5 minutes
DISCUSSION PRESENTATION: SAFETY PRECAUTIONS WHEN USING AN AED
When operating an AED, you should avoid certain actions and situations that could harm you, other responders or bystanders and the person who is being assisted. Take the following precautions when operating an AED: Do not use alcohol to wipe the persons chest dry. Alcohol is flammable. Do not use incorrect size pads, unless there are no other pads around. Persons older than 8 years of age or weighing more than 55 pounds should have adult AED pads. Children under age 8 or less than 55 pounds should have pediatric pads, which provide a lower level of electricity. If the correctly sized pads are not available, then you may use the other sized pads. Do not touch the person while the AED is analyzing. Touching or moving the person may affect analysis. Before shocking a person with an AED, make sure that no one is touching or is in contact with the person or any resuscitation equipment. Do not touch the person while the AED is defibrillating. You or others could be shocked. Do not defibrillate someone around flammable or combustible materials, such as gasoline or free-flowing oxygen.
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SAFETY PRECAUTIONS WHEN USING AN AED Continued
Do not use an AED in a moving vehicle. Movement may affect the analysis. Do not use an AED on a person who is in contact with water. If a person is in water, remove him or her from the water before defibrillation. A shock delivered in water could harm responders or bystanders. Be sure there are no puddles around you, the person or the AED. Remove wet clothing to place the pads properly, if necessary. Dry the persons chest and attach the AED pads. If it is raining, take steps to ensure that the person is as dry as possible and sheltered from the rain. Ensure that the persons chest is wiped dry. Minimize delaying defibrillation when taking steps to provide for a dry environment. AEDs are very safe, even in rain and snow, when all precautions and manufacturers operating instructions are followed. Do not use an AED on a person wearing a nitroglycerin patch or other medical patch on the chest. With a gloved hand, remove any patches from the chest before attaching the device. Never place AED pads directly on top of medication patches. Do not use a mobile phone or radio within 6 feet of the AED. Radiofrequency interference (RFI) and electromagnetic interference (EMI), as well as infrared interference generated by radio signals, could interrupt analysis. If an implantable device is visible or you know that the person has one, do not place the defibrillation pads directly over the implanted device. This may interfere with the delivery of the shock. Adjust pad placement if necessary, and continue to follow the AED instructions. If you are not sure whether the person has an implanted device, use the AED if needed. It will not harm the person or responder. If a person with hypothermia is unconscious and not breathing, begin CPR until an AED becomes readily available. If the person is wet, remove his or her wet clothing and dry the chest, then attach the AED pads. If a shock is indicated, deliver a shock. If the person is still not breathing, continue CPR. Protect the person from further heat loss. However, CPR or defibrillation should not be withheld to re-warm the person. Do not shake a person with hypothermia unnecessarily as this could result in V-fib. If a person is in cardiac arrest resulting from traumatic injuries, an AED may still be used. Chest hair rarely interferes with pad adhesion. Press firmly on the pads to attach them to the persons chest. If you get a check pads or similar message from the AED, remove the pads and replace them with new ones. The pad adhesive may pull out some of the chest hair, which may solve the problem. If you continue to get the check pads message, remove the pads, shave the persons chest where the pads will be placed, and attach new pads to the persons chest. If a person is lying on a metal surface (such as bleachers), it is safe to deliver a shock to the person as long as you make sure the pads do not make contact with the metal surface and no one is touching the person when the shock button is pressed. It is not necessary to remove jewelry or body piercings when using an AED. However, do not place the pads directly on the jewelry.
LESSON
13
AEDAdult
83
DRAFT TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
Damage to the heart from disease or injury can disrupt the hearts electrical system causing an abnormal heart rhythm. The two most common abnormal rhythms leading to cardiac arrest are ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach). Most people in sudden cardiac arrest need an electrical shock called defibrillation. An AED is a device that analyzes the hearts rhythm and, if necessary, advises you to deliver a shock to a person in sudden cardiac arrest. Early defibrillation is the third link in the Cardiac Chain of Survival. Answer participants questions. Review the skill sheets, CPRAdult (No Breathing) and AEDAdult or Child Older than 8 Years or Weighing More than 55 Pounds in Chapter 6 of the textbook.
ACTIVITY ASSIGNMENT
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DRAFT

SKILL CHART: AEDADULT OR CHILD OLDER THAN 8 YEARS OR WEIGHING MORE THAN 55 POUNDS
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. Tip: Do not use pediatric AED pads or equipment on an adult or on a child older than 8 years or weighing more than 55 pounds. After checking the scene and the injured or ill person: 1. Turn on the AED. Follow the voice and/or visual prompts. 2. Wipe the bare chest dry. Tip: Remove any medication patches with a gloved hand. 3. Attach pads. 4. Plug in the connector, if necessary. 5. Stand clear. Make sure that no one, including you, is touching the person. Say, EVERYONE STAND CLEAR. 6. Analyze heart rhythm. Push the analyze button if necessary. Let the AED analyze the heart rhythm. 7. Deliver shock. If shock is advised: Make sure that no one, including you, is touching the person. Say, EVERYONE STAND CLEAR. Push the shock button if necessary. 8. Perform CPR. After delivering the shock, or if no shock is advised: Perform about 2 minutes (or 5 cycles) of CPR. Continue to follow the prompts of the AED. Tips: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. If two trained responders are present, one should perform CPR while the second responder operates the AED.
SKILL ASSESSMENT TOOL: AEDADULT OR CHILD OLDER THAN 8 YEARS OR WEIGHING MORE THAN 55 POUNDS
Criteria Attach AED pads to bare chest. Proficient Places one pad on upper right chest Places one pad on left side of chest Not Proficient Places one pad on upper left chest Places both pads on same side of chest Places one or more pads on location other than chest Make sure that no one is touching the person. Says, Everyone stand clear (before pushing the analyze button if necessary) Says, Everyone stand clear (before pushing the shock button if necessary) Does not say, Everyone stand clear. Pushes analyze button if necessary, before saying, Everyone stand clear. Pushes the shock button if necessary, before saying, Everyone stand clear. Returns to chest compressions after 3 or more seconds
After delivering the shock, or if no shock is advised, perform about 2 minutes of CPR.
Returns to chest compressions within 2 seconds
LESSON
13
AEDAdult
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LESSON
14
DRAFT
ADULT AED SKILL PRACTICE AND SCENARIOS

LESSON OBJECTIVES
After completing the skill sessions, participants should be able to: Demonstrate how to perform CPR and use an AED to care for an adult in cardiac arrest.

To complete this lesson and meet the lesson objectives, you must: Show the video segment, Putting It All Together: CPRAdult. Conduct the skill session for using an AED on an adult. Conduct the scenarios for performing CPR and using an AED on an adult.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, Adult AED Skill Practice and Scenarios LCD projector, screen and computer Skill Charts: CPRAdult (No Breathing) and AEDAdult or Child Older than 8 Years or Weighing More than 55 Pounds Skill Assessment Tools: CPRAdult (No Breathing) and AEDAdult or Child Older than 8 Years or Weighing More than 55 Pounds AED training devices and pads (one for every two participants) Nonlatex disposable gloves (multiple sizes) CPR breathing barriers (face shields or resuscitation masks, one for each participant) Adult manikins (one for every two participants) Decontamination supplies Blankets or mats Written handouts of scenarios (optional) Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 3 minutes
DISCUSSION
Assign partners or ask participants to find a partner. Tell participants that they will have a set time to review and practice the skills for performing CPR and using an AED on an adult. Inform them that after the skill practice session, they will break up into small groups and be presented with a scenario in which they will be required to perform the skills and decision making that would be appropriate as lay responders.
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DRAFT TOPIC:
VIDEO
SKILL PRACTICE SESSION
Time: 15 minutes
Show the video segment, Putting It All Together: CPRAdult (2:03 minutes).
PRESENTATION: PUTTING IT ALL TOGETHER: CPRADULT

SKILL SESSION
Ask the participants to take the textbook, nonlatex disposable gloves and breathing barriers to the practice area. Tell participants that they will be using the skill sheets in Chapter 6 of the textbook. Using breathing barrier, nonlatex disposable gloves and the AED training device on an adult manikin, guide the participants as a group through the steps for using an AED. Assign partners or ask the participants to find a partner. One participant acts as the responder and the other observes. Have participants practice the skill following the voice prompts of their own training device, while their partner uses the skill sheet to give feedback. After the participants are able to practice the skill correctly, have them change places and repeat the skill. Guide the participants through the skill, beginning with checking the scene and the person and ending with a recovery position. Give feedback when appropriate or help when requested. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
TOPIC:
SKILL SCENARIOS
Time: 25 minutes
DISCUSSION
Tell participants that they will: Split into several small groups with each group receiving a scenario to role-play using a manikin. Be responsible for preparing for the role-playing activity by gathering any necessary equipment and supplies and designating the roles for each group member. Formulate a response to the scenario integrating what they have previously learned. Inform participants that you will: Communicate the setup for the scenario. Observe their skills and decision making as responders. Lead the responders through the scenarios, prompting them as a group. Provide prompts throughout the scenario.
Instructors Note: Because participants are going to simulate responding to a real emergency situation, provide only the information necessary for responders to make a decision and give care. In other words, prompt the responder only to the conditions found, such as Breaths do not go in instead of Give a rescue breath. Instructors Note: For Scenario 1, have participants switch roles. For Scenario 2, have one participant complete the scenario while the second participant observes.
LESSON
14
Adult AED Skill Practice and Scenarios
87
DRAFT
SCENARIO 1
SETU P PRESENTATION: SCENARIO 1
A construction worker is loading wood onto a front-end loader. The construction worker starts feeling pain in his chest and collapses. Several workers nearby see what happens and head toward the scene, but do not know what to do. You are in the ofce, on your way out of the building at the time of the crash. You grab the rst aid kit and quickly approach the worker. The scene appears to be safe. You do not suspect a head, neck or spinal injury. An AED is available. You are the only one trained in adult CPR and AED. Instructors Note: Set AED trainer to a 1-shock scenario. One participant should be the lead responder, another should act as the bystander who will be instructed to ensure that emergency medical services (EMS) is activated and the AED is brought to the scene. The lead responder should check the scene and then the person. Once the lead responder directs someone to call 9-1-1, he or she continues checking the person and gives appropriate care. After the rst shock, the AED trainer will prompt the lead responder to perform CPR before analysis is reinitiated.
ACTION STEPS
Participant Action: The lead responder follows the emergency action steps: CHECKCALLCARE. Taps and shouts: Are you OK? Instructor: No response. Participant Action: Go call 9-1-1. We have an unconscious adult. Bring the AED from the office. Then opens the airway and looks, listens and feels for movement and breathing and quickly scans for bleeding. Instructor: There are no signs of life and no active bleeding. Participant Action: The lead responder begins CPR. Instructor: After observing several cycles, say: The bystander arrives with an AED and conrms that EMS is on the way. Participant Action: The lead responder turns on and prepares the AED for use and applies the pads. The lead responder reminds all to stand clear during analyzing and when shock is advised. Following the voice prompts of the AED, the lead responder gives 1 shock, gives CPR for about 2 minutes, and then the AED reanalyzes. No shock is advised. Participant Action: The lead responder begins CPR. Instructor: After CPR is begun, an obvious sign of life is found. Participant Action: The lead responder stops CPR and announces that the man should be monitored for breathing and any changes in condition until EMS personnel arrive.
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SCENARIO 2
A woman in her 50s is at the community center preparing for a birthday party. She thinks that the signals she feels are nothing more than a little stress about the upcoming event. The woman eventually collapses and is unconscious. You are a neighbor also preparing for the party and you respond quickly, telling the womans son to call 9-1-1 and to then bring the rst aid kit and an AED machine. You give care until EMS arrives. You will follow the emergency action steps: CHECKCALLCARE. You are the only person trained in both adult CPR and adult AED. The scene is safe. You have a rst aid kit and an AED readily available. Instructors Note: Set AED trainer to a 2-shock scenario. One participant should be the lead responder while another should act as the bystander who will be instructed to ensure that emergency medical services (EMS) is activated and the AED is brought to the scene. The lead responder should check the scene and then the person. Once the lead responder directs someone to call 9-1-1, he or she continues checking the person and gives appropriate care. Responder 1 should be allowed to begin care and complete a few cycles of CPR before the rst aid kit and AED arrive. After the rst shock, the AED trainer will prompt the responder to perform CPR before analysis is reinitiated for a second shock. Remind them to count out loud.
ACTION STEPS
Participant Action: The lead responder follows the emergency action steps: CHECKCALLCARE. The lead responder taps and shouts: Are you OK? Instructor: No response. Participant Action: Go call 9-1-1. We have an unconscious adult. And bring the AED. The responder then opens the airway and looks, listens and feels for movement and breathing, and quickly scans for severe bleeding. Instructor: There are no signs of life and no active bleeding. Participant Action: The lead responder begins CPR. Instructor: After observing several cycles, say: A bystander arrives with an AED and conrms EMS is on the way. Participant Action: The lead responder turns on and prepares the AED for use and applies the pads. The lead responder reminds all to stand clear during analyzing and when shock is advised. Following the voice prompts of the AED, the lead responder gives 1 shock, gives CPR for about 2 minutes, and then the AED reanalyzes. It announces, Shock advised. Participant Action: EVERYONE, STAND CLEAR. Responder gives 1 shock followed by 2 minutes of CPR. AED reanalyzes and prompts. No shock is advised. Participant Action: The lead responder resumes CPR.
LESSON
14
89
DRAFT
SKILL SCENARIOS Continued

Instructor: The woman is breathing and shows other signs of life. Participant Action: The lead responder stops CPR and announces that the woman should be monitored for breathing and any changes in condition until EMS personnel arrive.
TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Learning to recognize the signals of a heart attack and responding immediately can reduce the risk of cardiac arrest occurring. If a person experiences cardiac arrest, the greatest chance of survival occurs when the Cardiac Chain of Survival (early recognition and early access, early CPR, early defibrillation and early advanced medical care) happens as rapidly as possible. Answer participants questions. Review the skill sheet, AEDChild and Infant Younger than 8 Years or Weighing Less than 55 Pounds in Chapter 6 of the textbook.
ACTIVITY ASSIGNMENT
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DRAFT

SKILL CHART: CPRADULT (NO BREATHING)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill person: 1. Give 30 chest compressions. Push hard, push fast in the center of the chest. Compress the chest at least 2 inches deep for an adult. Compress at a rate of at least 100 times per minute. Tip: The person must be on a firm, flat surface. 2. Give 2 rescue breaths. Tilt the head back and lift the chin up. Pinch the nose shut then make a complete seal over the persons mouth. Blow in for about 1 second to make the chest clearly rise. Give rescue breaths, one after the other. If the chest does not rise with the first rescue breath, retilt the head and give another rescue breath. 3. Do not stop. Continue cycles of CPR. Do not stop except in one of these situations: You find an obvious sign of life such as breathing. An AED is ready to use. Another trained responder or EMS personnel take over. You are too exhausted to continue. The scene becomes unsafe. Tip: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. What to do next: Use an AED as soon as one is available. If breaths do not make the chest riseGive CARE for unconscious choking.
SKILL ASSESSMENT TOOL: CPRADULT (NO BREATHING)

Criteria Compress chest at least 2 inches deep for an adult. Let chest rise completely before pushing down again. Proficient Compresses chest straight down at least 2 inches for 2430 times per 30 compressions Compresses and fully releases chest without pausing or taking hands off chest for 2430 times per 30 compressions Not Proficient Compresses chest less than 2 inches for 7 or more times per 30 compressions Pauses or fails to fully release chest while compressing for 7 or more times per 30 compressions
LESSON
14
91
DRAFT
SKILL ASSESSMENT TOOL: CPRADULT (NO BREATHING) Continued
Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds). Give rescue breaths. Compresses chest 2436 times in about 18 seconds Compresses chest less than 24 or more than 36 times in about 18 seconds Gives 2 rescue breaths that do not make the chest clearly rise Gives 2 rescue breaths that last 2 or more seconds Gives rescue breaths and returns to chest compressions but takes 7 or more seconds
Gives rescue breaths that make the chest clearly rise Gives rescue breaths that last about 1 second
Return to compressions.
Gives rescue breaths and returns to chest compressions within 36 seconds
SKILL CHART: AEDADULT OR CHILD OLDER THAN 8 YEARS OR WEIGHING MORE THAN 55 POUNDS
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. Tip: Do not use pediatric AED pads or equipment on an adult or on a child older than 8 years or weighing more than 55 pounds. After checking the scene and the injured or ill person: 1. Turn on the AED. Follow the voice and/or visual prompts. 2. Wipe the bare chest dry. Tip: Remove any medication patches with a gloved hand. 3. Attach pads. 4. Plug in the connector, if necessary. 5. Stand clear. Make sure that no one, including you, is touching the person. Say, EVERYONE STAND CLEAR. 6. Analyze heart rhythm. Push the button marked analyze if necessary. Let the AED analyze the heart rhythm. 7. Deliver shock. If shock is advised: Make sure that no one, including you, is touching the person. Say, EVERYONE STAND CLEAR. Push the shock button if necessary. 8. Perform CPR. After delivering the shock, or if no shock is advised: Perform about 2 minutes (or 5 cycles) of CPR. Continue to follow the prompts of the AED. Tips: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. If two trained responders are present, one should perform CPR while the second responder operates the AED.
SKILL ASSESSMENT TOOL: AEDADULT OR CHILD OLDER THAN 8 YEARS OR WEIGHING MORE THAN 55 POUNDS
Criteria Attach AED pads to bare chest. Proficient Places one pad on upper right chest Places one pad on left side of chest Not Proficient Places one pad on upper left chest Places both pads on same side of chest Places one or more pads on location other than chest
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SKILL ASSESSMENT TOOL: AEDADULT OR CHILD OLDER THAN 8 YEARS OR WEIGHING MORE THAN 55 POUNDS Continued
Make sure that no one is touching the person. Says, Everyone stand clear (before pushing the analyze button if necessary) Says, Everyone stand clear (before pushing the shock button if necessary) Does not say, Everyone stand clear. Pushes analyze button if necessary, before saying, Everyone stand clear. Pushes the shock button if necessary, before saying, Everyone stand clear. Returns to chest compressions after 6 or more seconds
LESSON
14
93
LESSON
15
DRAFT
AEDCHILD AND INFANT

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe the general steps for the use of an automated external debrillator (AED) on a child or infant.
After completing the skill session, participants should be able to: Demonstrate how to use an AED to care for a child or infant in cardiac arrest.

To complete this lesson and meet the lesson objectives, you must: Show the video segment, Using an AED. Conduct the skill session for using an AED on a child and infant.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, AEDChild and Infant LCD projector, screen and computer Skill Chart: AEDChild and Infant Younger than 8 Years or Weighing Less than 55 Pounds Skill Assessment Tool: AEDChild and Infant Younger than 8 Years or Weighing Less than 55 Pounds AED training devices and pediatric pads (one for every two participants) Nonlatex disposable gloves (multiple sizes) CPR breathing barriers (face shields or resuscitation masks, one for each participant) Child/infant manikins (one for every two participants) Decontamination supplies Blankets or mats Newsprint or chalkboard Markers or chalk Participant Progress Log (Appendix E or Instructors Corner)
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DRAFT TOPIC:
INTRODUCTION
Time: 3 minutes
AEDs equipped with pediatric pads are capable of delivering lower levels of energy considered appropriate for a child up to 8 years of age or weighing less than 55 pounds. If pediatric-specific equipment is not available, use an AED designed for adults on children and infants. Follow the same general steps and precautions that you would when using an AED on an adult in cardiac arrest.
TOPIC:
AUTOMATED EXTERNAL DEFIBRILLATION

Show the video segment, Using an AED (2:04 minutes). Instructors Note:
Time: 15 minutes
VIDEO
PRESENTATION: USING AN AED
If desired, replay the video segment focusing on Using an AED Child and Infant, from approximately 2:39 minutes to 3:33.
TOPIC:
USING AN AEDCHILD AND INFANT
Time: 22 minutes
SKILL SESSION: AEDCHILD AND INFANT
Ask the participants to take the textbook, nonlatex disposable gloves and breathing barriers to the practice area. Tell participants that they will be using the skill sheet in Chapter 6 of the textbook. Using nonlatex disposable gloves and the AED training device on a pediatric manikin, guide the participants as a group through the steps for using an AED. Assign partners or ask the participants to find a partner. One participant acts as the responder while the other observes. Have the participant acting as the responder from each pair kneel beside the manikin and clean or prepare the manikin for use and then practice using the AED training device. Give feedback when appropriate or help when requested. After the participants are able to practice the skill correctly, have them change places. Repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
LESSON
15
AEDChild and Infant
95
DRAFT TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
AEDs equipped with pediatric AED pads are capable of delivering lower levels of energy to a child or infant up to age 8 years or weighing less than 55 pounds. Early defibrillation is the third link in the Cardiac Chain of Survival. Answer participants questions. Review the skill sheet, CPRChild (No Breathing), CPRInfant (No Breathing) and AEDChild and Infant Younger than 8 Years or Weighing Less than 55 Pounds in Chapter 6 of the textbook.
ACTIVITY ASSIGNMENT
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DRAFT
Skill Chart and Assessment Tool

SKILL CHART: AEDCHILD AND INFANT YOUNGER THAN 8 YEARS OR WEIGHING LESS THAN 55 POUNDS
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. Tip: When available, use pediatric settings or pads when caring for children and infants. If pediatric equipment is not available, rescuers may use AEDs configured for adults. After checking the scene and the injured or ill child or infant: 1. Turn on the AED. Follow the voice and/or visual prompts. 2. Wipe the bare chest dry. 3. Attach pads. If the pads risk touching each other, use the front-to-back pad placement. 4. Plug in the connector, if necessary. 5. Stand clear. Make sure that no one, including you, is touching the child or infant. Say, EVERYONE STAND CLEAR. 6. Analyze heart rhythm. Push the analyze button, if necessary. Let the AED analyze heart rhythm. 7. Deliver shock. If shock is advised: Make sure that no one, including you, is touching the child or infant. Say, EVERYONE STAND CLEAR. Push the shock button. 8. Perform CPR. After delivering the shock, or if no shock is advised: Perform about 2 minutes (or 5 cycles) of CPR. Continue to follow the prompts of the AED. Tips: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. If two trained responders are present, one should perform CPR while the second responder operates the AED.
SKILL ASSESSMENT TOOL: AEDCHILD AND INFANT YOUNGER THAN 8 YEARS OR WEIGHING LESS THAN 55 POUNDS
Criteria Attach AED pads to bare chest. Proficient Places one pad on upper right chest Places one pad on left side of chest Not Proficient Places one pad on upper left chest Places both pads on same side of chest Places one or more pads on location other than chest Make sure that pads do not touch. Places pads on chest so that they are separated from each other and so that the heart is between two pads OR Places one pad in the middle of the chest Places one pad on the back centered between the shoulder blades (Pads are placed so that the heart is between the two pads.) Places pads on chest but pads touch each other OR Places the center of one pad more than 2 inches from the center of the chest Places the center of one pad more than 2 inches from the center of both shoulder blades
LESSON
15
AEDChild and Infant
97
DRAFT
SKILL ASSESSMENT TOOL: AEDCHILD AND INFANT YOUNGER THAN 8 YEARS OR WEIGHING LESS THAN 55 POUNDS Continued
Make sure that no one is touching the person. Says, Everyone stand clear (before pushing the analyze button if necessary) Says, Everyone stand clear (before pushing the shock button if necessary) Does not say, Everyone stand clear. Pushes analyze button if necessary, before saying, Everyone stand clear. Pushes the shock button if necessary, before saying, Everyone stand clear. Returns to chest compressions after 6 or more seconds
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LESSON
DRAFT 16
CHILD AED SKILL PRACTICE AND SCENARIOS

LESSON OBJECTIVES
After completing the skill sessions, participants should be able to: Demonstrate how to perform CPR and use an AED to care for a child and infant in cardiac arrest.

To complete this lesson and meet the lesson objectives, you must: Show the video segment, Putting It All Together: CPRInfant. Conduct the skill session for using an AED on a child and infant. Conduct the scenarios for performing CPR and using an AED on a child or infant.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, Child AED Skill Practice and Scenarios LCD projector, screen and computer Skill Charts: CPRChild (No Breathing), CPRInfant (No Breathing) and AEDChild and Infant Younger than 8 Years or Weighing Less than 55 Pounds Skill Assessment Tools: CPRChild (No Breathing), CPRInfant (No Breathing), and AEDChild and Infant Younger than 8 Years or Weighing Less than 55 Pounds AED training devices and pads (one for every two participants) Nonlatex disposable gloves (multiple sizes) CPR breathing barriers (face shields or resuscitation masks, one for each participant) Child or infant manikins (one for every two participants) Decontamination supplies Blankets or mats Written handouts of scenarios (optional) Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 3 minutes
DISCUSSION
Assign partners or ask participants to find a partner. Tell participants that they will have a set time to review and practice the skills for performing CPR and using an AED on a child and infant. Inform them that after the skill practice session, they will break up into small groups and be presented with a scenario in which they will be required to perform the skills and decision making that would be appropriate as lay responders.
LESSON
16
Child AED Skill Practice and Scenarios
99
DRAFT TOPIC:
VIDEO
SKILL PRACTICE SESSION
Time: 15 minutes
Show the video segment, Putting It All Together: CPRInfant (1:52).
PRESENTATION: PUTTING IT ALL TOGETHER: CPRINFANT

SKILL SESSION
Ask the participants to take the participants manual, nonlatex disposable gloves and breathing barriers to the practice area. Tell participants that they will be using the skill sheets in Chapter 6 of the textbook. Using breathing barriers, nonlatex disposable gloves and the AED training device with pediatric pads on a child or infant manikin, guide the participants as a group through the steps for using an AED. Assign partners or ask the participants to find a partner. One participant acts as the responder while the other observes. Have participants practice the skill following the voice prompts of their own training device, while their partner uses the skill sheet to give feedback. After the participants are able to practice the skill correctly, have them change places and repeat the skill. Guide the participants through the skill, beginning with checking the scene and the person and ending with a recovery position. Give feedback when appropriate or help when requested. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
TOPIC:
SKILL SCENARIOS
Time: 25 minutes
DISCUSSION
Tell participants that they will: Split into several small groups with each group receiving a scenario to role-play using a manikin. Be responsible for preparing for the role-playing activity by gathering any necessary equipment and supplies and designating the roles for each group member. Formulate a response to the scenario integrating what they have previously learned. Inform participants that you will: Communicate the setup for the scenario. Observe their skills and decision making as responders. Lead the responders through the scenarios, prompting them as a group. Provide prompts throughout the scenario.
Instructors Note: Because participants are going to simulate responding to a real emergency situation, provide only the information necessary for responders to make a decision and give care. In other words, prompt the responder only to the conditions found, such as Breaths do not go in instead of Give a rescue breath.
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DRAFT
SKILL SCENARIOS Continued
Instructors Note: For both scenarios, have one participant complete the scenario while the second participant observes.
SCENARIO 1
SETU P
The rst graders are playing a game in the class, when a 7-year-old child starts running and then suddenly collapses to the ground. The scene is safe. You check and nd that he is unconscious and does not appear to have any injuries. You tell an assistant teacher to call 9-1-1 and get the AED with pediatric pads as you continue to check the child. You are the only person trained in child and infant CPR and AED. Instructors Note: Set trainer to a 2-shock scenario. One participant should be the responder while another should act as the bystander who will be instructed to ensure that EMS is activated and the AED with pediatric pads is brought to the scene. Once the responder directs someone to call 9-1-1, he or she continues checking the child and gives appropriate care. After the rst shock, the AED trainer will prompt the responder to perform CPR before analysis is reinitiated for a second shock.
PRESENTATION: SCENARIO 1
ACTION STEPS
Participant Action: Responder follows the emergency action steps: CHECKCALLCARE. Instructor: The child is unconscious. Participant Action: Responder instructs an assistant teacher to CALL 9-1-1 or the local emergency number and get the AED. Checks child for breathing and severe bleeding. Instructor: The child is not breathing and there is no active bleeding. Participant Action: Responder gives CARE by giving CPR. Instructor: After observing several cycles of CPR, says: The assistant teacher arrives with the AED and conrms that 9-1-1 has been called. Participant Action: Responder turns on and prepares AED for use, verifying pediatric pads. Applies the pediatric pads and says, EVERYONE, STAND CLEAR. Responder allows the AED to analyze and gives 1 shock. Responder gives CPR for about 2 minutes. Responder 2 then says, EVERYONE, STAND CLEAR, allows the AED to reanalyze. No shock is advised. Responder 1 begins CPR again. Instructor: After CPR is begun, the child then shows an obvious sign of life. Participant Action: Responder indicates that the child should be monitored for breathing and any changes in condition.
LESSON
16
101
DRAFT
SCENARIO 2
While at a family gathering in a local amusement park, you and the other adults are sitting around a picnic table talking about your sisters 8-month old son, who is nearby in a stroller. During the conversation, you look over to the stroller and notice that the infant is motionless. You are the only one trained in child and infant CPR and AED. Instructors Note: Set AED trainer to a 1-shock scenario. One participant should be the responder while another should act as the bystander who will be instructed to ensure that EMS is activated and the AED with pediatric pads is brought to the scene. Once the responder directs someone to call 9-1-1, he or she continues checking the child and gives appropriate care. After the rst shock, the AED trainer will prompt the responder to perform CPR before analysis is reinitiated for a second shock.
ACTION STEPS
Participant Action: Follows emergency action steps: CHECKCALLCARE. Instructor: The infant is unconscious. Participant Action: Responder instructs someone (a family member) to CALL 9-1-1 or the local emergency number and get the AED. Checks child for breathing and severe bleeding. Instructor: The child is not breathing and there is no active bleeding. Participant Action: Responder gives 2 rescue breaths. Instructor: The chest clearly rises. Participant Action: Responder gives CARE by giving CPR. Instructor: After observing several cycles of CPR, says: A family member arrives with the AED and conrms that 9-1-1 has been called. Participant Action: Responder turns on and prepares AED for use, verifying pediatric pads. Responder applies the pediatric pads. Instructor: The pads are touching each other. Participant Action: Responder positions pads, one in the middle of the infants chest and the other on the infants back between the shoulder blades. Says EVERYONE, STAND CLEAR. Allows the AED to analyze. Gives 1 shock. Gives 2 minutes of CPR then AED reanalyzes and prompts No shock advised. Responder resumes CPR. Instructor: The infant is now breathing. Participant Action: Responder indicates that the infant should be monitored for breathing and any changes in condition.
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DRAFT TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Learning to recognize the signals of a cardiac emergency in a child or infant and responding immediately can improve the childs or infants chances for survival. If a child or infant experiences cardiac arrest, the greatest chance of survival occurs when the Cardiac Chain of Survival (early recognition and early access, early CPR, early defibrillation and early advanced medical care) happens as rapidly as possible. Answer participants questions. Read Chapter 7 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
LESSON
16
103
DRAFT

SKILL CHART: CPRCHILD (NO BREATHING)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill child: 1. Give 30 chest compressions. Push hard, push fast in the center of the chest. Compress the chest about 2 inches deep for a child. Compress at a rate of at least 100 times per minute. Tip: The child must be on a firm, flat surface. 2. Give 2 rescue breaths. Tilt the head back and lift the chin up. Pinch the nose shut then make a complete seal over the childs mouth. Blow in for about 1 second to make the chest clearly rise. Give rescue breaths, one after the other. If the chest does not rise with the first rescue breath, retilt the head and give another rescue breath. 3. Do not stop. Continue cycles of CPR. Do not stop except in one of these situations: You find an obvious sign of life such as breathing. An AED is ready to use. Another trained responder or EMS personnel take over. You are too exhausted to continue. The scene becomes unsafe. Tip: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. What to do next: Use an AED as soon as one is available. If breaths do not make the chest riseGive CARE for unconscious choking.
SKILL ASSESSMENT TOOL: CPRCHILD (NO BREATHING)

Criteria Compress chest about 2 inches deep for a child. Let chest rise completely before pushing down again. Proficient Compresses chest straight down at least 1 inches for 2430 times per 30 compressions Compresses and fully releases chest without pausing or taking hands off chest for 2430 times per 30 compressions Compresses chest 2436 times in about 18 seconds Not Proficient Compresses chest less than 1 inches for 7 or more times per 30 compressions Pauses or fails to fully release chest while compressing for 7 or more times per 30 compressions Compresses chest less than 24 or more than 36 times in about 18 seconds
Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds).
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SKILL ASSESSMENT TOOL: CPRCHILD (NO BREATHING) Continued
Give rescue breaths. Gives rescue breaths that make the chest clearly rise Gives rescue breaths that last about 1 second Return to compressions. Gives rescue breaths and returns to chest compressions within 36 seconds Gives 2 rescue breaths that do not make the chest clearly rise Gives 2 rescue breaths that last 2 or more seconds Gives rescue breaths and returns to chest compressions but takes 7 or more seconds
SKILL CHART: CPRINFANT (NO BREATHING)

In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill infant: 1. Give 30 chest compressions. Push hard, push fast in the center of the chest. Compress the chest about 1 inches deep. Compress at a rate of at least 100 times per minute. Let the chest rise completely before pushing down again. Tip: The infant must be on a firm, flat surface. 2. Give 2 rescue breaths. Tilt the head back and lift the chin up. Make a complete seal over the infants mouth and nose. Blow in for about 1 second to make the chest clearly rise. Give rescue breaths, one after the other. If chest does not rise with the first rescue breath, retilt the head and give another rescue breath. 3. Do not stop. Continue cycles of CPR. Do not stop except in one of these situations: You find an obvious sign of life, such as breathing. An AED is ready to use. Another trained responder or EMS personnel take over. You are too exhausted to continue. The scene becomes unsafe. Tip: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. What to do next: Use an AED as soon as one is available. If breaths do not make the chest riseGive CARE for unconscious choking.
LESSON
16
105
DRAFT
SKILL ASSESSMENT TOOL: CPRINFANT (NO BREATHING)
Criteria Compress chest about 1 inches deep. Let the chest rise completely before pushing down again. Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds). Give rescue breaths. Proficient Compresses chest straight down at least 1 inches for 2430 times per 30 compressions Compresses and releases chest without pausing for 2430 times per 30 compressions Compresses chest 2436 times in about 18 seconds Gives rescue breaths that make the chest clearly rise Gives rescue breaths that last about 1 second Return to compressions. Gives rescue breaths and returns to chest compressions within 36 seconds Not Proficient Compresses chest less than 1 inches for 7 or more times per 30 compressions Pauses while compressing or releasing for 7 or more times per 30 compressions Compresses chest less than 24 or more than 36 times in about 18 seconds Gives 2 rescue breaths that do not make the chest clearly rise Gives 2 rescue breaths that last 2 or more seconds Gives rescue breaths and returns to chest compressions but takes 7 or more seconds
SKILL CHART: AEDCHILD AND INFANT YOUNGER THAN 8 YEARS OR WEIGHING LESS THAN 55 POUNDS
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill.
Tip: When available, use pediatric settings or pads when caring for children and infants. If pediatric equipment
is not available, rescuers may use AEDs configured for adults. After checking the scene and the injured or ill child or infant: 1. Turn on the AED. Follow the voice and/or visual prompts. 2. Wipe the bare chest dry. 3. Attach pads. If the pads risk touching each other, use the front-to-back pad placement. 4. Plug in the connector, if necessary. 5. Stand clear. Make sure that no one, including you, is touching the child or infant. Say, EVERYONE STAND CLEAR. 6. Analyze heart rhythm. Push the analyze button, if necessary. Let the AED analyze heart rhythm. 7. Deliver shock. If shock is advised: Make sure that no one, including you, is touching the child or infant. Say, EVERYONE STAND CLEAR. Push the shock button. 8. Perform CPR. After delivering the shock, or if no shock is advised: Perform about 2 minutes (or 5 cycles) of CPR. Continue to follow the prompts of the AED. Tips: If at any time you notice an obvious sign of life, stop CPR and monitor breathing and for any changes in condition. If two trained responders are present, one should perform CPR while the second responder operates the AED.
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SKILL ASSESSMENT TOOL: AEDCHILD AND INFANT YOUNGER THAN 8 YEARS OR WEIGHING LESS THAN 55 POUNDS
Criteria Attach AED pads to bare chest. Proficient Places one pad on upper right chest Places one pad on left side of chest Not Proficient Places one pad on upper left chest Places both pads on same side of chest Places one or more pads on location other than chest Make sure that pads do not touch (child or infant). Places pads on chest so that they are separated from each other and so that the heart is between two pads OR Places one pad in the middle of the chest Places one pad on the back centered between the shoulder blades Make sure that no one is touching the person. Says, Everyone stand clear (before pushing the analyze button if necessary) Says, Everyone stand clear (before pushing the shock button if necessary) Places pads on chest but pads touch each other OR Places the center of one pad more than 2 inches from the center of the chest Places the center of one pad more than 2 inches from the center of both shoulder blades Does not say, Everyone stand clear. Pushes analyze button if necessary, before saying, Everyone stand clear. Pushes the shock button if necessary, before saying, Everyone stand clear. Returns to chest compressions after 6 or more seconds
LESSON
16
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LESSON
17
DRAFT
BREATHING EMERGENCIES
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify the causes of breathing emergencies. Identify conditions that cause respiratory distress and respiratory arrest. Identify signals of respiratory distress and respiratory arrest. Describe the care for a person in respiratory distress and respiratory arrest. Identify signals of asthma. Describe the care for a person having an asthma attack.

To complete this lesson and meet the lesson objectives, you must: Identify the two major types of breathing emergencies. Conduct the activity related to causes of breathing emergencies. Review the conditions associated with causing respiratory distress and respiratory arrest. Engage the participants in a verbal discussion about the signals of respiratory distress and respiratory arrest. Discuss the care necessary for a person experiencing respiratory distress and respiratory arrest. Show the video segment, Assisting with an Asthma Inhaler. Discuss the signals of asthma. Describe the medications available for persons diagnosed with asthma.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, Breathing Emergencies LCD projector, screen and computer Newsprint or chalkboard Markers or chalk
TOPIC:
INTRODUCTION

Time: 5 minutes
A breathing emergency is any respiratory problem that can threaten a persons life. Respiratory distress and respiratory arrest are examples of breathing emergencies, and can have a variety of causes including asthma and other illnesses. Airway obstruction is one of the most common causes of breathing emergencies. There are two types. An anatomical airway obstruction occurs when the airway is blocked by the tongue or swollen tissues of the mouth and throat. This type of obstruction may result from injury to the neck or a medical emergency, such as anaphylaxis.
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DRAFT
A mechanical airway obstruction occurs when the airway is partially or completely blocked by a foreign object, such as a piece of food or a small toy, by fluids, such as vomit or blood, or by mucous. A person with a mechanical airway obstruction is choking. It is important to recognize breathing emergencies in children and infants and act before the heart stops beating. When the heart stops in a child or infant, it usually is the result of a breathing emergency. No matter what the age of the person, trouble breathing can be the first signal of a more serious emergency, such as a heart problem. Recognizing the signals of breathing problems and giving care often are the keys to preventing these problems from becoming more serious emergencies. The human body needs a constant supply of oxygen to survive. The goal in a breathing emergency is for air to reach the lungs. For any person, regardless of age, it is important to keep the airway open when giving care. In some breathing emergencies the oxygen supply to the body is greatly reduced, whereas in others the oxygen supply is cut off entirely. As a result, the heart soon stops beating and blood no longer moves through the body. Without oxygen, brain cells can begin to die within 4 to 6 minutes. Unless the brain receives oxygen within minutes, permanent brain damage or death will result.
TOPIC:
RESPIRATORY DISTRESS AND RESPIRATORY ARREST

Time: 7 minutes
DISCUSSION PRESENTATION: RESPIRATORY DISTRESS AND RESPIRATORY ARREST
Two types of breathing emergencies are respiratory distress and respiratory arrest. Respiratory distress is a condition in which breathing becomes difficult or requires extra effort. Respiratory arrest occurs when breathing stops. Normal breathing is regular, quiet and effortless. You can usually identify a breathing problem by watching and listening to a persons breathing and by asking the person how he or she feels.
CAUSES OF BREATHING EMERGENCIES ACTIVITY

Ask participants to identify causes of breathing emergencies in adults and children. Record their responses on newsprint or chalkboard.
Instructors Note: Responses should include: choking (partially or completely obstructed airway); illness; chronic respiratory conditions, such as emphysema or asthma; electrocution; irregular heartbeat; heart attack; injury to the head or brain stem, chest, lungs, or abdomen; allergic reactions; anaphylaxis; drug overdose; poisoning; emotional distress; and drowning. Causes in children and infants also include respiratory infections, such as croup and epiglottitis. Use this list of causes when discussing the next section on Conditions.
LESSON
17
Breathing Emergencies
109
DRAFT TOPIC:
COMMON CONDITIONS THAT CAUSE RESPIRATORY DISTRESS AND RESPIRATORY ARREST

Time: 10 minutes
DISCUSSION
PRESENTATION: RESPIRATORY ARREST AND RESPIRATORY DISTRESS
Respiratory distress is the most common breathing emergency. It is important to recognize respiratory distress because it can lead to respiratory arrest if left untreated or mismanaged. Respiratory distress and respiratory arrest can be caused by a variety of conditions.
COPD
DISCUSSION PRESENTATION: COPD

Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung disease encompassing both chronic bronchitis and emphysema. A person has trouble breathing because of damage to the lungs. The airways become partially blocked and the air sacs in the lungs lose their ability to fill with air, making it difficult to breathe in and out. The most common cause of COPD is cigarette smoking. Breathing in other types of lung irritants, pollutants, dust or chemicals over a long period of time also can cause COPD. Common signals of COPD include: Coughing up a large volume of mucus. Tendency to tire easily. Loss of appetite. Bent posture with shoulders raised and lips pursed to make breathing easier. A fast pulse. Round, barrel-shaped chest. Confusion (caused by lack of oxygen to the brain). Emphysema, a type of COPD, is a chronic disease that involves damage to the air sacs in the lungs and worsens over time. The most common signal is shortness of breath. Exhaling is extremely difficult. In advanced cases, the person may feel restless, confused and weak and may even go into respiratory or cardiac arrest. Bronchitis is an inflammation of the main air passages to the lungs. It can be acute, usually occurring after a viral respiratory infection, or chronic, which is a type of COPD. Signals of both types of bronchitis include: Chest discomfort. Cough that produces mucus. Fatigue. Fever (usually low). Shortness of breath that worsens with activity. Wheezing.
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COPD Continued
Additional signals of chronic bronchitis include: Ankle, feet and leg swelling. Blue lips. Frequent respiratory infections.
HYPERVENTILATION
DISCUSSION PRESENTATION: HYPERVENTILATION

Hyperventilation occurs when a persons breathing is faster and deeper than normal. When this happens, the body does not take in enough oxygen to meet its demands. Hyperventilation is often the result of fear and anxiety. It also can be caused by head injuries, severe bleeding or illnesses, such as high fever, heart failure, lung disease or diabetic emergencies. It can also be triggered by asthma or exercise. People who are hyperventilating feel as if they cannot get enough air. They are often afraid and anxious or seem confused. They may say they feel dizzy or that their fingers and toes feel numb or tingly.
ALLERGIC REACTIONS
DISCUSSION PRESENTATION: ALLERGIC REACTIONS

An allergic reaction is the response of the immune system to a foreign substance that enters the body. Common allergens include bee or insect venom, antibiotics, pollen, animal dander, sulfa and some foods, such as nuts, peanuts, shellfish, strawberries and coconut oils. Allergic reactions can cause breathing problems. At first, the reaction may appear to be just a rash and a feeling of tightness in the chest and throat, but this condition can become life threatening. The persons face, neck and tongue may swell, closing the airway. Anaphylaxis, also known as anaphylactic shock, is a severe allergic reaction. During anaphylaxis, air passages swell and restrict a persons breathing. Signals include: Rash. Tightness in the chest and throat. Swelling of the face, neck and tongue. Dizziness or confusion. Anaphylaxis is a life-threatening emergency. People who know they are allergic to certain things may carry medication, such as an epinephrine auto-injector, to reverse the allergic reaction or may wear a medical identification tag, bracelet or necklace.
CROUP
DISCUSSION PRESENTATION: CROUP

Croup is a harsh, repetitive cough that most commonly affects children younger than 5 years. The airway constricts, limiting the passage of air, which causes the child to produce an unusual-sounding cough that can range from a high-pitched wheeze to a barking cough. The cough associated with croup mostly occurs during the evening and nighttime. Most children with croup can be cared for at home using mist treatments or cool air. In some cases, a child with croup can progress quickly from respiratory distress to respiratory arrest.
LESSON
17
111
DRAFT
EPIGLOTTITIS
DISCUSSION PRESENTATION: EPIGLOTTITIS

Epiglottitis causes severe swelling of the epiglottis, a piece of cartilage at the back of the tongue. When it swells, it can block the windpipe and lead to severe breathing problems. Epiglottitis is usually caused by infection with Haemophilus inuenza bacteria. The signals of epiglottitis may be similar to those of croup but epiglottitis is a more serious illness and can result in death if the airway becomes blocked completely. For children and adults, epiglottitis begins with a high fever and sore throat. The person may need to sit up and lean forward, perhaps with the chin thrust out in order to breathe. Other signals including drooling, trouble swallowing, voice changes, chills, shaking and fever. Epiglottitis is a medical emergency. Seek medical care immediately for the person who may have epiglottitis.
TOPIC:
SIGNALS OF RESPIRATORY DISTRESS AND RESPIRATORY ARREST
Time: 5 minutes
DISCUSSION PRESENTATION: SIGNALS OF RESPIRATORY DISTRESS PRESENTATION: SIGNALS OF RESPIRATORY ARREST
Signals of respiratory distress in adults include: Trouble breathing. Slow or rapid breathing. Unusually deep or shallow breathing. Gasping for breath. Trouble speaking or trouble speaking in complete sentences. Wheezing, gurgling or making high-pitched noises. Snoring or grunting sounds when breathing. Unusually moist or cool skin. Flushed, pale, ashen or bluish skin. Shortness of breath. Dizziness or light-headedness. Pain in the chest or tingling in the hands, feet or lips. Apprehensive or fearful feelings. Signals of respiratory distress in children and infants include: Agitation. Unusually fast or slow breathing. Drowsiness. Noisy breathing. Nasal flaring. Chest appears to sink in with each breath (intercostal retractions) Pale, ashen, flushed or bluish skin. Trouble breathing. Altered level of consciousness. Increased heart rate.
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SIGNALS OF RESPIRATORY DISTRESS AND RESPIRATORY ARREST Continued
Signals for a person in respiratory arrest include: Unresponsiveness. Absence of breathing. Ashen or cyanotic skin color.
TOPIC:
CARE FOR RESPIRATORY DISTRESS AND RESPIRATORY ARREST
Time: 8 minutes
DISCUSSION PRESENTATION: CARE FOR RESPIRATORY DISTRESS AND RESPIRATORY ARREST
To care for an adult, child or infant with a breathing emergency, you should: Check the scene to ensure your own safety before you approach a person (for example, presence of toxic fumes). Check the person for consciousness. If the person is conscious, you know that he or she is breathing and that his or her heart is beating. Call 9-1-1 or the local emergency number if breathing is too fast, too slow, noisy, painful or if the person is not breathing at all. Even if the person is conscious, respiratory distress is a life-threatening emergency and requires immediate care from EMS personnel. If possible, send someone to call 9-1-1 or the local emergency number. Continue to check for other life-threatening conditions, such as severe bleeding. Care for the conditions you find. Specific care for an adult, child or infant who is having trouble breathing includes: Help the person rest in a comfortable position. Usually, sitting is more comfortable than lying down because it is easier for the person to breathe in a sitting position. If the person is conscious, check for other conditions. Remember that a person who has trouble breathing may have trouble talking. If the person cannot talk, ask him or her to nod or to shake his or her head to answer yes-or-no questions. If bystanders are present, they may be able to help answer questions about the persons condition. Try to reassure the person to reduce anxiety. This may make breathing easier. Continue to monitor the person. Watch for additional signals of respiratory distress. Keep the person from getting chilled or overheated. Assist a person with asthma with the use of prescribed, quick-relief asthma medication if needed. Also assist the person in taking any other prescribed medication (e.g., oxygen or an inhalant [bronchodilator]) for his or her condition, if trained and if state or local regulations allow. Assist a person experiencing anaphylaxis with his or her epinephrine auto-injector if needed. You may need to assist with a second dose in a situation where signals of anaphylaxis persist after several minutes, or return, and EMS is delayed. You will learn more about giving care for anaphylaxis in Chapter 16. If the person is hyperventilating and you are sure that it is caused by emotion, such as excitement, tell him or her to relax and breathe slowly. You can also suggest that the person breathe through pursed lips (as if whistling) or pinch one nostril and breathe through his or her nose. Reassurance is often enough to correct hyperventilation. If the breathing still does not slow down, the person could have a serious problem.
LESSON
17
113
DRAFT
CARE FOR RESPIRATORY DISTRESS AND RESPIRATORY ARREST Continued
Be aware that a persons airway may become completely blocked as a result of epiglottitis. A blocked airway is a life-threatening emergency and needs immediate medical help. If an adult is unconscious and not breathing, the cause is most likely a cardiac emergency. Immediately begin CPR starting with chest compressions. If an adult is not breathing because of a known respiratory cause, such as drowning, give 2 rescue breaths after checking for breathing and before quickly scanning for severe bleeding and beginning CPR or modified CPR (as taught in Lesson 20) beginning with CPR chest compressions. If a child or infant is unconscious and not breathing, and you did not witness a sudden collapse, give 2 rescue breaths after checking for breathing and before quickly scanning for severe bleeding and beginning CPR or modified CPR (as taught in Lessons 20 and 21).
TOPIC:
VIDEO
ASTHMA
Show the video segment: Assisting with an Asthma Inhaler (3:08).
Time: 8 minutes
PRESENTATION: ASSISTING WITH AN ASTHMA INHALER DISCUSSION PRESENTATION: ASTHMA

You often can tell when a person is having an asthma attack by the hoarse whistling sound known as wheezing, made while the person is inhaling and/or exhaling. Coughing after exercise, crying or laughing are other signals that an asthma attack could begin. Additional signals of an asthma attack include: Trouble breathing or shortness of breath. Rapid, shallow breathing. Sweating. Tightness in the chest. Inability to talk without stopping for a breath. Feelings of fear or confusion. If a person is having an asthma attack, call 9-1-1 or the local emergency number if the persons breathing trouble does not improve in a few minutes after using the quick-relief medication. Additional steps to take include: Remain calm. This will help the person to also remain calm and ease his or her breathing troubles. Help the person to sit comfortably. Loosen any tight clothing around the neck and abdomen. Assist the person with his or her prescribed quick-relief medication if requested and if permitted by state or local regulations.
Instructors Note: An optional lesson for assisting with an asthma inhaler can be found on Instructors Corner.
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DRAFT TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Breathing emergencies are life-threatening conditions. As a lay responder, your role is to recognize the signals of a breathing emergency, call 9-1-1 or the local emergency number and give appropriate care. Answer participants questions. Review the skill sheets, Conscious ChokingAdult (Cannot Cough, Speak or Breathe) and Conscious ChokingChild (Cannot Cough, Speak or Breathe) in Chapter 7 of the textbook.
ACTIVITY ASSIGNM ENT
LESSON
17
115
LESSON
18
DRAFT
CONSCIOUS CHOKINGADULT AND CHILD

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify common causes of choking for adults and children. Describe the care for a conscious choking adult and child. After completing the skill session, participants should be able to: Demonstrate how to give care for a conscious choking adult and child.

To complete this lesson and meet the lesson objectives, you must: List the causes for and signals of choking in adults and children. Show the video segment, Conscious ChokingAdult and Child. Conduct the skill session for giving care to a conscious choking adult and child.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, Conscious ChokingAdult and Child LCD projector, screen and computer Skill Charts: Conscious ChokingAdult and Child (Cannot Cough, Speak or Breathe) Skill Assessment Tools: Conscious ChokingAdult and Child (Cannot Cough, Speak or Breathe) Nonlatex disposable gloves (multiple sizes) Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 3 minutes
Choking is a common breathing emergency. Choking occurs when the persons airway is partially or completely blocked by a foreign object, such as a piece of food or a small toy; by swelling in the mouth or throat; or by fluids, such as vomit or blood. With a partially blocked airway, the person usually can breathe with some trouble. A person whose airway is completely blocked cannot cough, speak, cry or breathe at all
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DRAFT TOPIC:
CAUSES AND SIGNALS OF CONSCIOUS CHOKING ADULT AND CHILD
Time: 10 minutes
CAUSES OF CHOKING
DISCUSSION
PRESENTATION: CAUSES OF CHOKING
Common causes of choking in adults include: Trying to swallow large pieces of poorly chewed food. Drinking alcohol before or during meals. Dentures. Eating while talking excitedly or laughing, or eating too fast. Walking, playing or running with food or objects in the mouth. Choking is a common cause of injury and death in children younger than 5 years because young children put nearly everything in their mouths. Food is responsible for most choking incidents in children. Toys and household items also can be hazardous. The American Academy of Pediatrics (AAP) recommends the following: No hard, smooth foods, such as raw vegetables, for young children No peanuts until after age 7 years No round or firm foods such as hot dogs and carrot sticks unless they are chopped into small pieces no larger than inch The AAP also recommends keeping the following foods away from children who are under age 5: Hard, gooey or sticky candy Grapes Popcorn Chewing gum Vitamins Toys and household items that can be hazardous include: Broken or non-inflated balloons. Baby powder. Objects from the trash, such as eggshells and pop-tops from beverage cans. Safety pins. Coins. Marbles. Pen and marker caps. Small button-type batteries.
SIGNALS OF CHOKING
DISCUSSION

PRESENTATION: SIGNALS OF CHOKING
An obstructed airway is a life-threatening emergency. A person with a partial airway obstruction can still move air to and from the lungs, so he or she can cough in an attempt to dislodge the object. A person who is choking may clutch his or her throat with one or both hands as a natural reaction. This is called the universal distress signal for choking. A person with a complete airway obstruction is unable to cough, speak, cry or breathe, or may cough weakly and inefficiently or make high-pitched noises as he or she attempts to get enough air to sustain life. The person may have a bluish skin color. You need to recognize the signals of an obstructed airway and take immediate action.
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LESSON
DRAFT TOPIC:
CARE FOR CONSCIOUS CHOKINGADULT OR CHILD
Time: 30 minutes
VIDEO
Show the video segment, Conscious ChokingAdult and Child (2:25 minutes).
PRESENTATION: CONSCIOUS CHOKING ADULT AND CHILD

DISCUSSION
PRESENTATION: CARE FOR CONSCIOUS CHOKING ADULT OR CHILD
If the person is coughing forcefully or wheezing, do not interfere with attempts to cough up the object. Stay with the person and encourage him or her to continue coughing to clear the obstruction. If coughing persists, call 9-1-1 or the local emergency number. For a complete airway obstruction: Act at once! If a bystander is available, have him or her call 9-1-1 or the local emergency number while you begin care. Using more than one technique often is necessary to dislodge an object and clear a persons airway. Use a combination of 5 back blows followed by 5 abdominal thrusts, which are an effective way to clear the airway obstruction in a conscious adult or child. For a conscious child, use less force when giving back blows and abdominal thrusts and get down to his or her level. Chest thrusts are used in some instances when giving abdominal thrusts may not be the best method, such as when: You cannot reach far enough around the person to give effective abdominal thrusts. The person is obviously pregnant or known to be pregnant. To give chest thrusts: Stand behind the person, placing your arms under the persons armpits and around the chest. Make a fist as for abdominal thrusts and place the fist with the thumb side against the center of the persons breastbone. Grab the fist with your other hand and thrust inward. If you are alone and choking and no one is around to help, you can give yourself abdominal thrusts with your fist or press your abdomen over a firm object, such as the back of a chair, railing or sink. Whenever you are giving care to a conscious person who is choking, anticipate that the person will become unconscious if the obstruction is not removed. Ask the participants to take the textbook to the practice area. Tell participants that they will be using the skill sheets in Chapter 7 of the textbook. Assign partners or ask the participants to find a partner. Tell the participants that they will practice positioning their hands on their partner to give back blows and abdominal thrusts to a conscious choking adult. Emphasize that they will not give actual back blows or abdominal thrusts since doing so could cause harm.
SKILL SESSION: CONSCIOUS CHOKINGADU LT AND CHILD
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CARE FOR CONSCIOUS CHOKINGADULT OR CHILD Continued

Have half of the participants stand in a line or semi-circle with their partners behind them. Explain that responder body mechanics are important. To give back blows: Position yourself slightly behind and to the side of the person. Provide support by placing one arm diagonally across the chest and lean the person forward until the upper airway is at least parallel to the ground. To give abdominal thrusts: Stand or kneel behind the person. Wrap your arms around his or her waist. Guide the participants through the skill, beginning by checking the person. Give participants the appropriate prompt at each CHECK step and observe for the correct response. Give feedback when appropriate or help when requested. After the participants have practiced the skill to the point at which they feel comfortable in their ability to perform the skill, have them change places and repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Choking is a common breathing emergency and can be caused by either a partial or complete airway obstruction. Clutching the throat with one or both hands is the universal sign for choking. A person with a partial obstruction is coughing forcefully. Stay with the person and encourage him or her to continue coughing to clear the obstruction. A person with a complete obstruction cannot cough, speak, cry or breathe and requires a combination of back blows and abdominal thrusts to relieve the obstruction. Answer participants questions. Review the skill sheet, Conscious ChokingInfant (Cannot Cough, Cry or Breathe) in Chapter 7 of the textbook.
ACTIVITY ASSIGNMENT
LESSON
18
Conscious ChockingAdult and Child
119
DRAFT

SKILL CHART: CONSCIOUS CHOKINGADULT AND CHILD (CANNOT COUGH, SPEAK OR BREATHE)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill person, have someone call 9-1-1 and get consent. 1. Give 5 back blows. Bend the person forward at the waist and give 5 back blows between the shoulder blades with the heel of one hand. 2. Give 5 abdominal thrusts. Place a fist with the thumb side against the middle of the persons abdomen, just above the navel (within 2 inches) and well below the lower tip of the breastbone. Cover the fist with the other hand and give 5 quick, upward abdominal thrusts.* 3. Continue care. Continue sets of 5 back blows and 5 abdominal thrusts until the: Object is forced out. Person can cough forcefully or breathe. Person becomes unconscious. What to do next: If the person becomes unconsciousCALL 9-1-1, if not already done. Carefully lower the person to the ground and give CARE for an unconscious choking adult, beginning with looking for an object.
SKILL ASSESSMENT TOOL: CONSCIOUS CHOKING ADULT AND CHILD (CANNOT COUGH, SPEAK OR BREATHE)
Criteria Bend the person forward at the waist. Proficient Positions person with upper airway (persons head and neck) parallel to the ground or angled slightly downward Strikes the back with heel of one hand Strikes the center of the back between shoulder blades Not Proficient Positions person with upper airway (persons head and neck) angled upward Strikes the back with closed hand Strikes the back with palm Strikes the back more than 2 inches from the center of both shoulder blades Places fist more than 2 inches above the navel Places fist less than 1 inch from the lower tip of breastbone (too close to breastbone)
Give 5 back blows.
Give 5 abdominal thrusts.
Places fist within 2 inches above the navel Places fist 1 inch or more away from lower tip of breastbone
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LESSON
DRAFT 19
CONSCIOUS CHOKINGINFANT
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe the care for a conscious choking infant. After completing the skill session, participants should be able to: Demonstrate how to give care for a conscious choking infant.

To complete this lesson and meet the lesson objectives, you must: Discuss the care for a conscious choking infant. Show the video segment, Conscious ChokingInfant. Conduct the skill session for giving care to a conscious choking infant.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, Conscious ChokingInfant LCD projector, screen and computer Skill Chart: Conscious ChokingInfant (Cannot Cough, Cry or Breathe) Skill Assessment Tool: Conscious ChokingInfant (Cannot Cough, Cry or Breathe) Nonlatex disposable gloves (multiple sizes) Infant manikins (one for every two participants) Blankets or mats Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 3 minutes
An infant who cannot cough, cry or breathe has a completely obstructed airway. For a conscious choking infant, back blows and chest thrusts are used to clear the obstructed airway. Positioning of the infant for back blows and chest thrusts is important. The infants head and neck must be supported at all times.
LESSON
19
Conscious ChokingInfant
121
DRAFT TOPIC:
CARE FOR CONSCIOUS CHOKINGINFANT
Time: 40 minutes
VIDEO
Show the video segment, Conscious ChokingInfant (1:56 minutes).
PRESENTATION: CONSCIOUS CHOKING INFANT

SKILL SESSION: CONSCIOUS CHOKING INFANT
Ask the participants to take the textbook and nonlatex disposable gloves to the practice area. Tell participants that they will be using the skill sheet in Chapter 7 of the textbook to practice the skill on an infant manikin. Assign partners or ask the participants to find a partner. One partner will act as the responder while the other partner observes. Guide the participants through the skill, beginning by checking the person. Give participants the appropriate prompt at each CHECK step and observe for the correct response. Give feedback when appropriate or help when requested. After the participants have practiced the skill to the point at which they feel comfortable in their ability to perform the skill, have them change places and repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions. If a conscious infant cannot cough, cry or breathe, give 5 back blows followed by 5 chest thrusts. Positioning of the infant is important. To give back blows: Position the infant face-up on your forearm, supporting the head. Place one hand and forearm on the childs back, cradling the back of the head, and one hand and forearm on the front of the infant. Use your thumb and fingers to hold the infants jaw while sandwiching the infant between your forearms. Turn the infant over so that he or she is face-down on your forearm. Lower your arm onto your thigh so that the infants head is lower than his or her chest. To give chest thrusts: Place one hand and forearm on the childs back, cradling the back of the head, while keeping your other hand and forearm on the front of the infant. Use your thumb and fingers to hold the infants jaw while sandwiching the infant between your forearms. Turn the infant onto his or her back. Lower your arm that is supporting the infants back onto your opposite thigh. The infants head should be lower than his or her chest. Place the pads of two or three fingers in the center of the infants chest just below the nipple line (toward the infants feet). You can give back blows and chest thrusts effectively whether you stand or sit, as long as the infant is supported on your thigh. Continue back blows and chest thrusts until the object is forced out, the infant begins to breathe on his or her own, or the infant becomes unconscious.
DISCUSSION
PRESENTATION: CARE FOR CONSCIOUS CHOKING INFANT
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DRAFT TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
An infant who cannot cough, cry or breathe has a completely obstructed airway. For a conscious choking infant, back blows and chest thrusts are used to clear the obstructed airway. Remember to support the infants head and neck at all times. Answer participants questions. Review the skill sheet, Unconscious ChokingAdult (Chest Does Not Rise with Rescue Breaths) in Chapter 7 of the textbook.
ACTIVITY ASSIGNMENT
LESSON
19
123
DRAFT

SKILL CHART: CONSCIOUS CHOKINGINFANT (CANNOT COUGH, CRY OR BREATHE)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill infant, have someone call 9-1-1 and get consent from parent or guardian, if present. 1. Give 5 back blows. Give firm back blows with the heel of one hand between the infants shoulder blades. 2. Give 5 chest thrusts. Place two or three fingers in the center of the infants chest just below the nipple line (toward the feet) and compress the chest about 1 inches.
Tip: Support the head and neck securely when giving back blows and chest thrusts. Keep the head lower than the chest.
3. Continue care. Continue sets of 5 back blows and 5 chest thrusts until the: Object is forced out. Infant can cough forcefully, cry or breathe. Infant becomes unconscious.
What to do next: If infant becomes unconsciousCALL 9-1-1 if not already done. Carefully lower the infant on a firm, flat surface, and give CARE for an unconscious choking infant, beginning with looking for an object.
SKILL ASSESSMENT TOOL: CONSCIOUS CHOKINGINFANT (CANNOT COUGH, CRY OR BREATHE)

Criteria Keep the head lower than the chest. Proficient Positions infant with upper airway (infants head and neck) angled downward, lower than chest Places thumb and fingers on infants jaw Not Proficient Positions infant with upper airway (infants head and neck) parallel to ground or angled upward Places thumb on front of infants neck Places fingers on front of infants neck Places hand or fingers over the infants face (mouth and/or nose) Maintain firm support. Holds infant securely Drops infant Loses control of infant Give back blows. Strikes the back with the heel of one hand Strikes the center of the back between the shoulder blades Strikes the back with a closed hand Strikes the back with a palm Strikes the back more than 1 inch from the center of both shoulder blades Strikes the head or neck with fingers or hand Give chest thrusts. Places fingers in the center of the chest below the nipple line but above the xiphoid process (or not more than inch below the nipple line) Places fingers outside the center of chest Places fingers below the xiphoid process (or more than inch below the nipple line) Places fingers above the nipple line
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Support the head and neck securely.
LESSON
DRAFT 20
UNCONSCIOUS CHOKINGADULT AND CHILD

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe the care for an unconscious choking adult and child. After completing the skill session, participants should be able to: Demonstrate how to give care for an unconscious choking adult and child.

To complete this lesson and meet the lesson objectives, you must: Discuss the care for an unconscious choking adult and child. Show the video segment, Unconscious ChokingAdult and Child. Conduct the skill session for giving care to an unconscious choking adult and child.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, Unconscious ChokingAdult and Child LCD projector, screen and computer Skill Chart: Unconscious ChokingAdult and Child (Chest Does Not Rise with Rescue Breaths) Skill Assessment Tool: Unconscious ChokingAdult and Child (Chest Does Not Rise with Rescue Breaths) Nonlatex disposable gloves (multiple sizes) Adult and/or child manikins (one for every two participants) Breathing barriers (face shields or resuscitation masks, one for each participant) Blankets or mats Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 5 minutes
A conscious person who is choking may become unconscious if giving back blows and abdominal thrusts do not work to dislodge the object. You may also discover a person who is already unconscious, and may not know whether the person is choking at first. Unconsciousness is always a life-threatening condition. For an adult, call 9-1-1 or the local emergency number immediately. If you are alone and the person is a child or infant, give 2 minutes of care first and then call 9-1-1 or the local emergency number.
LESSON
20
Unconscious ChokingAdult and Child
125
DRAFT TOPIC:
CARE FOR UNCONSCIOUS CHOKINGADULT AND CHILD
Time: 35 minutes
DISCUSSION PRESENTATION: CARE FOR UNCONSCIOUS CHOKING ADULT AND CHILD
If a conscious choking adult or child becomes unconscious: Carefully lower the person to the floor. Call 9-1-1 or the local emergency number if not already done. Open the mouth and look for an object. If an object is seen, remove it with your gloved finger. If no object is seen, open the persons airway using the head-tilt/chin-lift technique and attempt 2 rescue breaths. If the persons chest rises and falls with each rescue breath, air is making it into the lungs. If the chest does not clearly rise, begin a modified CPR technique. If you discover an unconscious person and are not sure if they are choking: If during your check for other life-threatening conditions you find that an unconscious adult is not breathing, you should start CPR immediately with chest compressions. If the chest does not clearly rise after the first rescue breath in the cycle, re-tilt the head and give another rescue breath to ensure the airway is open. If that breath does not make the chest clearly rise, assume that the airway is blocked and use a modified CPR technique for unconscious choking. For a child who you discover unconscious and not breathing, 2 rescue breaths are included in the initial check for life-threatening conditions. If the chest does not clearly rise after the first rescue breath, re-tilt the head and give another rescue breath to ensure the airway is open. If the chest still does not clearly rise, use a modified CPR technique to care for unconscious choking. Do not stop modified CPR except in one of these situations: The object is removed and the chest clearly rises with rescue breaths (CPR may still be needed without the foreign object check). The person starts to breathe on his or her own. EMS personnel or another trained responder arrives and takes over. You are too exhausted to continue. The scene becomes unsafe. If the breaths make the chest clearly rise, quickly check for breathing. Care for the conditions you find including continuing CPR with 30 chest compressions if the person is not breathing.
VIDEO PRESENTATION: UNCONSCIOUS CHOKING ADULT AND CHILD SKILL SESSION U NCONSCIOUS CHOKINGADU LT AND CHILD
Show the video segment, Unconscious ChokingAdult and Child (2:19 minutes).
Ask the participants to take the textbook and nonlatex disposable gloves to the practice area. Tell participants that they will be using the skill sheet in Chapter 7 of the textbook to practice the skill on a manikin. Assign partners or ask the participants to find a partner. Guide the participants through the skill, beginning with checking the person. Give participants the appropriate prompt at each CHECK step and observe for the correct response. Give feedback when appropriate or help when requested.
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DRAFT
TOPIC: CARE FOR UNCONSCIOUS CHOKINGADULT AND CHILD Continued

After the participants have practiced the skill to the point at which they feel comfortable in their ability to perform the skill, have them change places and repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
At any time, a conscious choking adult or child can become unconscious. You might also discover a person who is unconscious, and discover they have an airway obstruction during CPR or, for children, during your initial check for life-threatening conditions. For an unconscious person with an airway obstruction begin a modified CPR technique that involves cycles of chest compressions, foreign object check/removal and 2 rescue breaths. Answer participants questions. Review the skill sheet, Unconscious ChokingInfant (Chest Does Not Rise with Rescue Breaths) in Chapter 7 of the textbook.
ACTIVITY ASSIGNMENT
LESSON
20
127
DRAFT

SKILL CHART: UNCONSCIOUS CHOKINGADULT AND CHILD (CHEST DOES NOT RISE WITH RESCUE BREATHS)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill person: 1. Give rescue breaths. Retilt the head and give another rescue breath. 2. Give 30 chest compressions. If the chest still does not rise, give 30 chest compressions. Tip: The person must be on a firm, flat surface. Remove the CPR breathing barrier when giving chest compressions. 3. Look for a foreign object and remove it if seen. 4. Give 2 rescue breaths. What to do next:

If breaths do not make the chest riseRepeat steps 2 through 4. If chest clearly risesCHECK for breathing. Give Care based on conditions found.
SKILL ASSESSMENT TOOL: UNCONSCIOUS CHOKING ADULT AND CHILD (CHEST DOES NOT RISE WITH RESCUE BREATHS)
Criteria Compress chest at least 2 inches deep for an adult. Compress chest about 2 inches deep for a child. Let chest rise completely before pushing down again. Proficient Compresses chest straight down at least 2 inches for 2430 times per 30 compressions Compresses chest straight down at least 1 inches for 2430 times per 30 compressions Compresses and fully releases chest without pausing or taking hands off chest for 2430 times per 30 compressions Compresses chest 2436 times in about 18 seconds Opens mouth and removes object with finger if seen Not Proficient Compresses chest less than 2 inches for 7 or more times per 30 compressions Compresses chest less than 1 inches for 7 or more times per 30 compressions Pauses or fails to fully release chest while compressing for 7 or more times per 30 compressions Compresses chest less than 24 or more than 36 times in about 18 seconds Opens mouth but does not remove object Fails to open mouth and look for object Give 2 rescue breaths. Gives rescue breaths that make the chest clearly rise Gives rescue breaths that last about 1 second Gives 2 rescue breaths that do not make the chest clearly rise Gives 2 rescue breaths that last 2 or more seconds
Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds). Look for a foreign object.
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SKILL ASSESSMENT TOOL: UNCONSCIOUS CHOKING ADULT AND CHILD (CHEST DOES NOT RISE WITH RESCUE BREATHS) Continued
Repeat cycles of chest compressions, foreign object check/ removal and 2 rescue breaths. Chest clearly rises. Completes 30 chest compressions, then looks for foreign object, and then gives 2 rescue breaths, looking for the chest to rise Checks for breathing for no more than 10 seconds Fails to compress the persons chest, do foreign object check/ removal, or give 2 rescue breaths Checks for breathing, taking longer than 10 seconds
LESSON
20
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LESSON
21
DRAFT
UNCONSCIOUS CHOKINGINFANT
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe the care for an unconscious choking infant. After completing the skill session, participants should be able to: Demonstrate how to give care for an unconscious choking infant.

To complete this lesson and meet the lesson objectives, you must: Discuss the care for an unconscious choking infant. Show the video segment, Unconscious ChokingInfant. Conduct the skill session for giving care to an unconscious choking infant.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, Unconscious ChokingInfant LCD projector, screen and computer Skill Chart: Unconscious ChokingInfant (Chest Does Not Rise with Rescue Breaths) Skill Assessment Tool: Unconscious ChokingInfant (Chest Does Not Rise with Rescue Breaths) Nonlatex disposable gloves (multiple sizes) Infant manikins (one for every two participants) Breathing barriers (face shields or resuscitation masks, one for each participant) Blankets or mats Participant Progress Log (Appendix E or Instructors Corner)
TOPIC:
INTRODUCTION

Time: 5 minutes
A conscious infant who is choking may become unconscious if giving back blows and chest thrusts do not work to dislodge the object. You may also discover an infant who is already unconscious, and may not know whether the infant is choking at first. Unconsciousness is always a life-threatening condition. Have someone call 9-1-1 or the local emergency number immediately. If you are alone, give an infant 2 minutes of care first and then call 9-1-1 or the local emergency number.
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DRAFT TOPIC:
CARE FOR UNCONSCIOUS CHOKINGINFANT
Time: 35 minutes
DISCUSSION PRESENTATION: CARE FOR UNCONSCIOUS CHOKING INFANT
If a conscious choking infant becomes unconscious: Carefully lower the infant to the ground. Call 9-1-1 or the local emergency number if not already done. Open the mouth and look for an object. If an object is seen, remove it with your gloved little finger. If no object is seen, open the infants airway by retilting the head and try to give 2 rescue breaths. If the infants chest rises and falls with each rescue breath, air is reaching the lungs. If the infants chest does not clearly rise, begin a modified CPR technique. If you discover an infant who is unconscious and not breathing and you did not witness the collapse, 2 rescue breaths are included in the initial check for life-threatening conditions. If the chest does not clearly rise after the first rescue breath, re-tilt the head and give another rescue breath to ensure the airway is open. If that breath does not make the chest clearly rise, assume that the airway is blocked and use a modified CPR technique to care for unconscious choking. Do not stop except in one of these situations: The object is removed and the chest clearly rises with rescue breaths (CPR may still be needed without the foreign object check). The infant starts to breathe on his or her own. EMS personnel or another trained responder arrives and takes over. You are too exhausted to continue. The scene becomes unsafe. If the breaths go in and the chest clearly rises, check for breathing for no more than 10 seconds. Care for the conditions you find including continuing CPR with 30 chest compressions if the infant is not breathing.
VIDEO PRESENTATION: UNCONSCIOUS CHOKING INFANT SKILL SESSION: U NCONSCIOUS CHOKING INFANT
Show the video segment, Unconscious ChokingInfant (1:36 minutes).
Ask the participants to take the textbook and nonlatex disposable gloves to the practice area. Tell participants that they will be using the skill sheet in Chapter 7 of the textbook to practice the skill on an infant manikin. Assign partners or ask the participants to find a partner. Guide the participants through the skill, beginning by checking the infant. Give participants the appropriate prompt at each CHECK step and observe for the correct response. Give feedback when appropriate or help when requested. After the participants have practiced the skill to the point at which they feel comfortable in their ability to perform the skill, have them change places and repeat the practice. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Use the remaining time to allow participants to continue practicing with partners to become more proficient with this skill. Answer participants questions.
LESSON
21
Unconscious ChokingInfant
131
DRAFT TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
At any time, a conscious choking infant can become unconscious. You might also discover an infant who is unconscious, and discover he or she has an airway obstruction during your initial check for life-threatening conditions. For an unconscious infant with an airway obstruction begin a modified CPR technique that involves cycles of chest compressions, foreign object check/removal and 2 rescue breaths. Answer participants questions. Read Chapter 8 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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DRAFT

SKILL CHART: UNCONSCIOUS CHOKINGINFANT (CHEST DOES NOT RISE WITH RESCUE BREATHS)
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and injured or ill infant: 1. Give rescue breaths. Retilt the head and give another rescue breath. 2. Give chest compressions. If chest still does not rise, give 30 chest compressions. Tip: The infant must be on a firm, flat surface. Remove the CPR breathing barrier when giving chest compressions. 3. Look for a foreign object and remove it if seen. 4. Give 2 rescue breaths. What to do next:

If breaths do not make the chest riseRepeat steps 2 through 4. If chest clearly risesCHECK for breathing. Give CARE based on the conditions found.
SKILL ASSESSMENT TOOL: UNCONSCIOUS CHOKINGINFANT (CHEST DOES NOT RISE WITH RESCUE BREATHS)
Criteria Compress chest at least 1 inches deep for an infant. Let chest rise completely before pushing down again. Proficient Compresses chest straight down at least 1 inches for 2430 times per 30 compressions Compresses and fully releases chest without pausing or taking hands off chest for 2430 times per 30 compressions Compresses chest 2436 times in about 18 seconds Opens mouth and removes object with little finger, if seen Not Proficient Compresses chest less than 1 inches for 7 or more times per 30 compressions Pauses or fails to fully release chest while compressing for 7 or more times per 30 compressions
Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds). Look for a foreign object.
Compresses chest less than 24 or more than 36 times in about 18 seconds Opens mouth but does not remove object Opens mouth and removes object if seen with finger other than little finger Fails to open mouth and look for object
LESSON
21
133
DRAFT
SKILL ASSESSMENT TOOL: UNCONSCIOUS CHOKINGINFANT (CHEST DOES NOT RISE WITH RESCUE BREATHS) Continued
Give 2 rescue breaths. Gives rescue breaths that make the chest clearly rise Gives rescue breaths that last about 1 second Repeat cycles of chest compressions, foreign object check/removal and 2 rescue breaths. Chest clearly rises. Completes 30 chest compressions, then looks for foreign object, and then gives 2 rescue breaths, looking for the chest to rise Checks for breathing for no more than 10 seconds Gives 2 rescue breaths that do not make the chest clearly rise Gives 2 rescue breaths that last 2 or more seconds Fails to compress the persons chest, do foreign object check/ removal, or give 2 rescue breaths Checks for breathing, taking longer than 10 seconds
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LESSON
DRAFT 22
BLEEDING
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Explain why severe bleeding must be controlled immediately. Identify two signals of life-threatening external bleeding. Describe the care for external bleeding. Describe how to minimize the risk of disease transmission when giving care in a situation that involves visible blood. After completing the skill sessions, participants should be able to: Demonstrate how to control minor and severe external bleeding. Demonstrate how to use a manufactured tourniquet.

To complete this lesson and meet the lesson objectives, you must: Describe bleeding, differentiating external from internal bleeding. Briey review the types of external bleeding based on the type of blood vessel injured. List the signals of external bleeding. Show the video segment, Controlling External Bleeding. Show the video segment, Applying a Manufactured Tourniquet (OPTIONAL) Describe the care for minor and severe external bleeding. Conduct the skill session for controlling minor and severe external bleeding. Conduct the skill session for using a manufactured tourniquet.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Three, Bleeding LCD projector, screen and computer Skill Charts: Controlling External Bleeding and Applying a Manufactured Tourniquet Skill Assessment Tools: Controlling External Bleeding and Applying a Manufactured Tourniquet Nonlatex disposable gloves (multiple sizes) Gauze pads (sterile) Roller bandages Manufactured tourniquets (one for every two participants) Adult manikins (one for every two participants) or a simulated limb Participant Progress Log (Appendix E or Instructors Corner)
LESSON
22
Bleeding
135
DRAFT TOPIC:
INTRODUCTION

Time: 5 minutes
Bleeding, the escape of blood from arteries, capillaries or veins, can be external, which is visible, or internal, which occurs inside the body and is often difficult to recognize. A large amount of bleeding occurring in a short amount of time is called a hemorrhage. Blood consists of a liquid component called plasma and solid components, such as red and white blood cells and platelets. It comprises about 7 percent of the bodys total weight. Blood has three major functions: Transports oxygen, nutrients and wastes Protects against disease by producing antibodies and defending against pathogens Maintains body temperature by circulating throughout the body Blood is channeled through blood vessels: arteries, which carry blood away from the heart; capillaries, which link the arteries and veins; and veins, which carry blood back to the heart. When bleeding occurs, the brain, heart and lungs immediately attempt to compensate for blood loss to maintain the flow of oxygen-rich blood to the body tissues, particularly to the vital organs. Uncontrolled external or internal bleeding is a life-threatening emergency.
TOPIC:
EXTERNAL BLEEDING

Time: 35 minutes
DISCUSSION PRESENTATION: EXTERNAL BLEEDING
External bleeding occurs when a blood vessel is opened externally such as through a break in the skin. Each type of blood vessel bleeds differently. Arterial bleeding is often rapid and severe, usually spurts from the wound because it is under great pressure, is difficult to control and is bright red in color due to its high oxygen content. Venous bleeding is generally easier to control and flows steadily from a wound without spurting. Only damage to deep veins produces severe bleeding that is difficult to control. Venous blood is dark red or maroon due to its poor oxygen content. Capillary bleeding, the most common type of bleeding, is slow, often oozes from the wound, clots easily, and usually is a paler red than arterial blood. Most external bleeding will be minor and easily controlled with direct pressure. In some cases, however, the damaged blood vessel will be too large or the blood will be under too much pressure for effective clotting to occur. In these cases, bleeding could be life threatening.
CARE FOR EXTERNAL BLEEDING

VIDEO SEGMENT PRESENTATION: CONTROLLING EXTERNAL BLEEDING PRESENTATION: APPLYING A MANUFACTURED TOURNIQUET

Show the video segment, Controlling External Bleeding (2:28 minutes). Show the video segment, Applying a Manufactured Tourniquet (1:22) (OPTIONAL)
DRAFT
CARE FOR EXTERNAL BLEEDING Continued
DISCUSSION PRESENTATION: CARE FOR EXTERNAL BLEEDING
Direct pressure, created by placing a sterile dressing and then a gloved hand or even a gloved hand by itself on a wound is the most effective means of controlling external bleeding. Pressure on a wound can be maintained by applying a bandage snugly to the injured area. This is called a pressure bandage. For severe external bleeding, follow these general steps: Call, or have someone call 9-1-1 or the local emergency number if you have not already done so. Put on disposable gloves. If blood has the potential to splatter, you may need to wear eye and face protection. Control external bleeding using the general steps below: Cover the wound with a dressing and press firmly against the wound with a gloved hand. Apply a pressure bandage over the dressing to maintain pressure on the wound and to hold the dressing in place. If blood soaks through the bandage, do not remove the blood-soaked bandages. Instead, add more pads and bandages to help absorb the blood and continue to apply pressure. Continue to monitor the persons condition. Observe the person closely for signals that may indicate that the persons condition is worsening, such as faster or slower breathing, changes in skin color and restlessness. Take steps to minimize shock. Keep the person from getting chilled or overheated. Have the person rest comfortably and reassure him or her. Wash your hands immediately after giving care, even if you wore gloves. A tourniquet is a tight band placed around an arm or leg to constrict blood vessels to stop blood flow to a wound. Because of the potential for adverse effects, a tourniquet should be used only as a last resort in the following situations: Cases of delayed care or situations in which response from emergency medical services (EMS) is delayed. Direct pressure does not stop the bleeding. You are not able to apply direct pressure. In most areas, application of a tourniquet is considered to be a skill at the emergency medical technician (EMT) level or higher and requires proper training. Ask participants to take the textbook, nonlatex disposable gloves, gauze pads, and roller bandages to the practice area. Tell participants that they will be using the skill sheet in Chapter 8 of the textbook. Assign partners or ask the participants to find a partner. Tell the participants that they will practice controlling external bleeding on each other with the assumption that the injured person is conscious. Have one participant care for a major wound on the forearm and then have the partners switch places and care for a similar wound. Guide the participants through the skill, starting with the recognition of severe bleeding. Remind participants of the need to follow standard precautions. Prompt the participants at the appropriate time by saying, The wound is still bleeding, to get them through the steps of using direct pressure and applying a pressure bandage. After the participants are able to practice the skill correctly, have them change places and repeat the practice. Give feedback when appropriate or help when requested. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after the skill has been performed successfully. Answer participants questions.
SKILL SESSION: CONTROLLING EXTERNAL BLEEDING
LESSON
22
Bleeding
137
DRAFT
CARE FOR EXTERNAL BLEEDING Continued
SKILL SESSION: APPLYING A MANU FACTU RED TOU RNIQU ET
Ask participants to take the textbook, nonlatex disposable gloves, gauze pads, roller bandages, and manufactured tourniquets, to the practice area. Tell participants that they will be using the skill sheet in Chapter 8 of the textbook. Assign partners or ask the participants to find a partner. Tell the participants that they will practice applying a manufactured tourniquet on the limb of an adult manikin. Assume the injured person is conscious.
Instructors Note: If manikins are not available and participants will be practicing the skill for applying the tourniquet on one another, tell them that they must only SIMULATE tightening of the tourniquet and they MUST NOT tighten the tourniquet.

Have one participant care for a major wound on the leg and then have the partners switch places and care for a similar wound. Guide the participants through the skill, starting with the recognition of severe bleeding. Remind participants of the need to follow standard precautions. Prompt the participants at the appropriate time by saying, The wound is still bleeding, to get them through the steps of using direct pressure and applying a pressure bandage. Also prompt the participants at the appropriate time by saying, EMS is delayed and the wound is still bleeding even after applying direct pressure. After the participants are able to practice the skill correctly, have them change places and repeat the practice. Give feedback when appropriate or help when requested. Check off participants skills on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed successfully. Answer participants questions.
TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
One of the most important things you can do in any emergency is to recognize and control life-threatening bleeding. Check for severe bleeding while checking for life-threatening conditions. External bleeding is easily recognized and should be cared for immediately by using direct pressure. Use a tourniquet only as a last resort. Always use standard precautions to avoid contact with the injured persons blood. Answer participants questions. Review Chapter 8 and complete the questions at the end of the chapters.
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DRAFT

SKILL CHART: CONTROLLING EXTERNAL BLEEDING
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured or ill person: 1. Cover the wound with a sterile dressing. 2. Apply direct pressure until bleeding stops. 3. Cover the dressing with a bandage. Check for circulation beyond the injury (check for feeling, warmth and color). 4. Apply more pressure and call 9-1-1. If bleeding does not stop: Apply more dressings and bandages and continue to apply additional pressure. Take steps to minimize shock. Call 9-1-1 if not already done. Tip: Wash hands with soap and water after giving care.
SKILL ASSESSMENT TOOL: CONTROLLING EXTERNAL BLEEDING

Criteria Use personal protective equipment. Proficient Puts on disposable gloves before covering wound Not Proficient Puts on disposable gloves after covering wound Does not put on disposable gloves Cover the wound with a (sterile) dressing and apply direct pressure until bleeding stops. Places dressing over site identified as wound area Applies pressure to wound Secures dressing in place with roller gauze Places dressing away from wound area Does not apply pressure Elevates wound Uses pressure points instead of direct pressure Secures dressing with roller gauze; dressing does not stay in place Apply additional dressings and more direct pressure (if bleeding does not stop). Adds additional dressings to initial dressing Applies pressure to wound Removes initial dressing Does not add additional dressings Does not apply pressure
LESSON
22
Bleeding
139
DRAFT
SKILL CHART: APPLYING A MANUFACTURED TOURNIQUET
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. NOTE: Always follow standard precautions and follow manufacturers instructions when applying a tourniquet. Call 9-1-1 or the local emergency number. 1. Position the tourniquet. Place tourniquet around the limb approximately 2 inches (about 2 finger widths) above the wound. Do not place tourniquet over a joint. 2. Pull strap through buckle. Route the tag end of the strap through the buckle if necessary. Pull the strap tightly and secure it in place 3. Twist the rod. Tighten the tourniquet by twisting the rod until the flow of bleeding stops and secure rod in place. Do not cover the tourniquet with clothing. 4. Record time. Note and record the time that you applied the tourniquet and give this information to more advanced medical personnel.
SKILL ASSESSMENT TOOL: APPLYING A MANUFACTURED TOURNIQUET

Criteria Position the tourniquet. Proficient Places tourniquet approximately 2 inches above the wound Avoids joint areas Not Proficient Places tourniquet closer than 2 inches above the wound Places tourniquet below the wound Places tourniquet over a joint area Pull strap tightly and secure it in place. Routes tag end through buckle as necessary Pulls strap snugly and secures it Tighten the tourniquet. Twists rod until bleeding stops Secures rod in place Does not cover tourniquet with clothing Note and record the time of application. Documents time of tourniquet application Gives information to more advanced medical personnel Twists rod but bleeding does not stop Fails to secure rod in place Covers tourniquet with clothing Does not document time of application Does not include information when reporting to more advanced medical personnel Does not pull strap tightly Fails to secure strap in place
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LESSON
DRAFT 23
INTERNAL BLEEDING/SHOCK
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify the signals of severe internal bleeding. Describe the care for minor internal bleeding. Identify the types of shock and the conditions that cause each of them. List the signals of shock. Explain what care can be given to minimize shock.

To complete this lesson and meet the lesson objectives, you must: List the signals of severe internal bleeding. Discuss the care for minor internal bleeding. Dene shock. Identify the signals of shock. Describe the care for a person experiencing shock.

Participants textbook Course Presentation: Part Three, Internal Bleeding/Shock LCD projector, screen and computer Newsprint or chalkboard Markers or chalk
TOPIC:
INTRODUCTION
Time: 3 minutes
Internal bleeding, the escape of blood from arteries, capillaries or veins into spaces in the body, is less obvious than external bleeding. However, internal bleeding can be life threatening. When the bodys ability to adapt to the physical stresses of injury or illness fail, the injured or ill person can progress into a life-threatening condition called shock.
TOPIC:
INTERNAL BLEEDING
Time: 12 minutes
DISCUSSION PRESENTATION: INTERNAL BLEEDING
Severe internal bleeding can occur from injuries caused by a blunt force, such as a motor vehicle driver being thrown against the steering wheel in a car crash, or a chronic medical condition, such as an ulcer. Internal bleeding may also occur when an object, such as a knife or bullet, penetrates the skin and damages internal structures. Always suspect internal bleeding with any traumatic injury.
LESSON
23
Internal Bleeding/Shock
141
DRAFT
SIGNALS OF INTERNAL BLEEDING
DISCUSSION PRESENTATION: SIGNALS OF INTERNAL BLEEDING

Severe internal bleeding is often difficult to recognize because the signals are not obvious and may take time to appear. Signals of severe internal bleeding include: Tender, swollen, bruised or hard areas of the body, such as the abdomen. Rapid breathing. Skin that feels cool or moist or looks pale or bluish. Vomiting blood or coughing up blood. Excessive thirst. An injured extremity that is blue or extremely pale. Altered mental state, such as the person becoming confused, faint, drowsy or unconscious. Many of these signals can also indicate shock, a progressive condition in which the circulatory system fails to circulate oxygen-rich blood to all parts of the body.
CARE FOR INTERNAL BLEEDING

DISCUSSION PRESENTATION: CARE FOR INTERNAL BLEEDING

Care for controlling internal bleeding depends on the severity and site of the bleeding. For minor internal bleeding, such as a bruise (also called a contusion): Apply an ice pack (preferred method) or a chemical cold pack to the injured site to reduce pain and swelling. Remember to place gauze or a towel between the source of cold and the skin to prevent damage to the skin. Do not assume that all closed wounds are minor injuries. If you suspect severe internal bleeding caused by serious injury, call 9-1-1 or the local emergency number immediately. While waiting for EMS personnel to arrive, follow these general care steps: Do no further harm. Monitor breathing and consciousness. Help the person rest in the most comfortable position. Keep the person from getting chilled or overheated. Reassure the person. Give any specific care needed.
Instructors Note: Care for specic injuries is included in Lesson 25, Care for Closed Wounds.
TOPIC:
SHOCK
Time: 25 minutes
DISCUSSION PRESENTATION: SHOCK
When the body is healthy, three conditions are needed to maintain adequate blood flow: The heart must be working well. The blood vessels must be intact and able to adjust blood flow. An adequate amount blood must be circulating in the body. When injury or sudden illness occurs, these normal body functions may be interrupted. With minor injuries or illnesses, the body is able to compensate quickly.
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When there are severe injuries or illnesses, the body may be unable to adjust. When the body is unable to meet its demand for oxygen because the circulatory system fails to adequately circulate oxygenated blood to all parts of the body, shock occurs.
Instructors Note: Refer participants to the sidebar, Shock: The Domino Effect, in Chapter 9 of the textbook for a description of how the body attempts to compensate in shock.
CAUSES OF SHOCK
DISCUSSION PRESENTATION: CAUSES OF SHOCK
There are many possible reasons for shock to occur including: Cardiogenic shock, resulting from failure of the heart to pump enough oxygenated blood. If the heart rate is too slow, the rate of new oxygenated blood cells reaching each part of the body will not be enough to keep up with the bodys demand. Likewise, when the heart beats too rapidly (ventricular tachycardia or ventricular fibrillation) the heart is not an effective pump, and oxygenated blood is not sent throughout the body as it should be. Damage to the heart can lead to weak and ineffective contractions; this can be related to trauma, disease (e.g., diabetes or cardiovascular disease), poisoning or respiratory distress. Distributive shock, resulting from the abnormal dilation of the blood vessels. If the blood vessels are not able to adequately constrict or become abnormally dilated, even though the blood volume is adequate and the heart is beating well, the vessels are not filled completely with blood. Since oxygen is absorbed into the body through the walls of the blood vessels, this condition leads to less oxygen being delivered to body. There are several types of distributive shock based on the cause. Abnormal dilation of the blood vessels can be caused by spinal cord or brain trauma (neurogenic/vasogenic shock), by infection (septic shock) or anaphylaxis (anaphylactic shock). Hypovolemic shock, resulting from severe bleeding or loss of fluid from the body. Insufficient blood volume can lead to shock. Also, if the levels of some components of the blood, such as plasma or fluids, become too low, blood flow will be impaired and shock can result. Hemorrhagic shock is the most common type of hypovolemic shock. It results from blood loss, either through external or internal bleeding. Other causes include severe vomiting, diarrhea and burns. Shock can also occur following any injury to the chest, obstruction of the airway or any other respiratory problem that decreases the amount of oxygen in the lungs. This means insufficient oxygen enters the bloodstream.
SIGNALS OF SHOCK
DISCUSSION PRESENTATION: SIGNALS OF SHOCK

You may not always be able to determine the cause of shock but remember that it is a life-threatening condition. Signals that indicate a person may be going into shock include: Apprehension, anxiety, restlessness or irritability. Altered level of consciousness. Nausea or vomiting. Pale, ashen or grayish, cool, moist skin. Rapid breathing. Excessive thirst.
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DRAFT
SHOCK Continued CARE FOR SHOCK
DISCUSSION PRESENTATION: CARE FOR SHOCK
Follow the emergency action steps: CHECKCALLCARE: CHECK the scene for safety and then the person. CALL 9-1-1 or the local emergency number immediately. Shock cannot be managed effectively by first aid alone. A person suffering from shock requires emergency medical care as soon as possible. CARE for the conditions you find. Any specific care you give for life-threatening conditions will help minimize the effects of shock. Caring for shock also includes the following actions: Be sure the persons airway is open and clear. Take steps to control any external bleeding and prevent further blood loss. If you see any suspected broken bones or dislocated or damaged joints, immobilize them in the position found to prevent movement that could cause more bleeding and damage. Often this is as simple as using the ground for support, or allowing the person to cradle an injured arm in a position of comfort. If possible, have the person lie down, or leave the person lying flat if already in this position. Help the person maintain normal body temperature, keeping the person from getting chilled or overheated. Do not give the person anything to eat or drink, even though he or she may ask. The person is likely to be thirsty due to fluid loss. However, the persons condition may be severe enough to require surgery, in which case it is better if the stomach is empty. Talk to the person in a calm and reassuring manner. Continue to monitor the persons breathing and for any changes in the persons condition. Do not wait for signals of shock to develop before caring for the underlying injury or illness.
TOPIC:
CLOSING

Time: 5 minutes
DISCUSSION
Although internal bleeding is less obvious, it can also be life threatening. Suspect internal bleeding when recognizing that a serious injury has occurred. Do not wait for shock to develop before giving care to a person who has an injury or sudden illness. Always follow the general care steps for any emergency to minimize the progression of shock. Activate the EMS system immediately by calling 9-1-1 or the local emergency number and give care as soon as possible until EMS personnel arrive and take over. Answer participants questions. Review Chapters 19.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 24
PUTTING IT ALL TOGETHER I (INTRODUCTION, ASSESSMENT, AND LIFE-THREATENING EMERGENCIES)

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Demonstrate the knowledge and skills learned in Lessons 123.

To complete this lesson and meet the lesson objectives, you must: Conduct the scenarios to evaluate participants knowledge of the conditions and demonstration of proper skills when giving care.

Participants textbook Course Presentation: Part Three, Putting it All Together I LCD projector, screen and computer CPR breathing barriers (face shields or resuscitation masks, one for each participant) Adult manikins (one for every two participants) AED training devices and pads (one for every two participants) Decontamination supplies Blankets or mats Sterile gauze pads Roller bandages Manufactured tourniquets Nonlatex disposable gloves (multiple sizes) Skill Charts from Lessons 123 (Chapters 19) Skill Assessment Tools from Lessons 123 (Chapter 19) Written handouts of scenarios (optional)
LESSON
24
Putting It All Together I (Introduction, Assessment, and Life-Threatening Emergencies)
145
DRAFT TOPIC:
ACTIVITY
INTRODUCTION
Time: 5 minutes
Tell participants that they: Will split into several small groups with each group receiving a scenario to role-play either using a participant as the injured or ill person, or a manikin. Will have approximately 5 minutes to prepare for the role-playing activity. Part of this preparation will include designating the roles to each of the group members who will role-play based on the actual scenario assigned and gather any necessary equipment and supplies. Are to formulate a response to the scenario by integrating the discussion points and skills from Chapters 19 and using the emergency action steps: CHECKCALLCARE to guide their responses. Should demonstrate any previously learned skills that would be required as part of the response, explaining their actions while providing care. Should be able to answer any questions asked by the instructor or other class members. Can explain their actions rather than demonstrate a skill if they feel it is necessary to use a skill that they have not yet learned. Will spend approximately 23 minutes after role-playing the scenario, critiquing their actions and discussing any problems, errors or difficulties they may have had. Read the scenario aloud to the class before beginning to role-play the scenario.
Instructors Note: If you are not using the presentation slides, provide each group with a written handout of the scenario for reference. Due to time constraints, select three of the ve scenarios provided for participants to demonstrate. You may choose to select all ve scenarios and continue them at the beginning of the next lesson. When evaluating the participants responses, be sure they address the following:

Did the groups plan follow the emergency action steps: CHECKCALLCARE? Did the plan involve bystanders appropriately? Did the plan demonstrate proper care?
TOPIC:
ACTIVITY
SCENARIO 1
Instructors Note:
Time: 12 minutes
This scenario addresses a conscious person with trouble breathing. For this scenario, there should be one participant acting as the responder, one acting as the injured person, and one acting as the person who called the responder. Setup: At work, you are called to assist a co-worker who has been injured in a 5-foot fall from a ladder. As you arrive, you notice the person sitting on the ground, writhing in pain and having trouble breathing as he clutches his arm to his chest. You want to help. How do you respond?
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SCENARIO 1 Continued
Instructors Note: The participants responses should include the following actions: Check the scene for safety. Because the person is conscious, the responder should begin a check by talking to him or her and getting his or her consent to give care. When the person responds, the responder should realize that the person has an open airway and is breathing. The responder should then scan the body to check for any severe bleeding. At this point, the responder should continue the check step by interviewing the person, beginning with questions that would determine how the person fell and where he or she was hurt. The responder should continue with a head-to-toe examination, being careful not to aggravate any injury, and speak in calm, reassuring manner. Once trouble breathing is evident, the responder should call 9-1-1 or the local emergency number and give care for him or her in whatever position he or she was found.
TOPIC:
ACTIVITY
SCENARIO 2
Instructors Note:
Time: 12 minutes
This scenario involves an unconscious person who is breathing. For this scenario, there should be one participant acting as the responder, one acting as the injured person and one acting as the neighbor. Setup A frantic neighbor is knocking at your door. She says that she cannot wake her sleeping roommate. She remembers that her roommate took some pills about 2 hours ago, but she is not sure what they were or where her roommate keeps them. You enter and see a woman lying face-up on the couch but is not moving. You want to help. How do you respond? Instructors Note: The participants responses should include the following actions: Check the scene for safety. The responder should begin with a check for consciousness. When the responder realizes the woman is unconscious, the responder should send the neighbor to call 9-1-1 or the local emergency number. Next, the responder should check for signs of life by opening the airway. The responder should realize that the person is breathing and therefore shows signs of life. A quick scan does not reveal any bleeding. The responder should care for the person by maintaining an open airway and continuing to closely monitor the person. Because unconsciousness is considered a life-threatening emergency, a further check for other conditions that are not immediately life threatening is not warranted.
LESSON
24
147
DRAFT TOPIC:
ACTIVITY PRESENTATION: SCENARIO 3
SCENARIO 3
Instructors Note:
Time: 12 minutes
This scenario involves an unconscious adult with no signs of life. For this scenario, there should be one participant acting as the responder and two acting as other gym members. Setup It is early morning, and you are working out at the gym. Only two other people are in the weight room. When you nish, you realize you have to hurry or be late for class. As you enter the locker room, you are startled to see a body lying motionless on the oor next to a row of lockers. You recognize the older person as one who had been lifting weights on a machine next to you. You want to help. How do you respond? Instructors Note: The participants responses should include the following actions: Check the scene for safety. The responder should begin with a check for consciousness. When the responder realizes the person is unconscious, the responder should yell for help since there is another person present who can call the emergency number for help. The responder should position the person on his or her back, open the airway and check for breathing. When the responder realizes the person is not breathing, the responder should check for severe bleeding and begin CPR.
TOPIC:
ACTIVITY
SCENARIO 4
Instructors Note:
Time: 12 minutes
This scenario involves an unconscious person with no signs of life. For this scenario, there should be one participant acting as the responder, one acting as the injured person and one acting as the neighbor. Setup Awakened in the early morning by screams and pounding on your front door, you rush to answer the door. You nd Mrs. Winters, your elderly neighbor from across the street. She knows you are trained in First Aid/CPR and asks you to please help her husband. As you hurry across the street, she tells you her husband had been feeling ill for several hours and then vomited. She says that he emerged from the bathroom clutching his chest and in apparent pain. He suddenly collapsed to the oor. As you enter the house, you nd Mr. Winters lying motionless on the oor just outside of the bathroom. You want to help. How do you respond? Instructors Note: The participants responses should include the following actions: Check the scene for safety. The responder should rst check for consciousness. When the responder realizes the person is unconscious, the responder should tell the neighbor to call 9-1-1 or the local emergency number. Next, the responder should position the person on his or her back, open the airway and check for breathing. Finding none, the responder should quickly scan the body to check for severe bleeding. CPR should be started immediately. Because cardiac arrest is a life-threatening emergency, a check for conditions that are not immediately life threatening is not warranted.
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SCENARIO 5
Instructors Note:
Time: 12 minutes
This scenario involves an unconscious person who is breathing with severe bleeding. For this scenario, there should be one participant acting as the responder, one acting as the injured person and one acting as a bystander. Setup You witness a bicyclist suddenly veer off the bike path, lose control of her bike and crash in the rough gravel on the side of the road. A bystander witnessed the accident and tells you that the bicyclist broke her fall with her body and did not strike her head. The bicyclist is wearing a helmet. As you approach, you see the bicyclist struggling to sit up, holding her thigh and moaning. Blood is spurting onto the pavement from a large, deep gash on the persons thigh. You want to help. How do you respond? Instructors Note: The participants responses should include the following actions: Check the scene for safety. Check the person. With the knowledge that the person is conscious and breathing, the responder knows that the person shows signs of life and should then check for severe bleeding. Heavy bleeding from the thigh should be controlled by either the responder or a bystander whom the responder has instructed to do so. The responder should send someone to call 9-1-1 or the local emergency number while the responder gives care. The responder should continue to monitor the person, recheck the wound to make sure bleeding is controlled and treat for shock. Severe bleeding is a life-threatening emergency, so a check for other conditions that are not immediately life threatening is not warranted.
TOPIC:
ACTIVITY
CLOSING

Time: 4 minutes
Briefly review the scenarios and the important elements of care. Answer participants questions. Read Chapter 10 and answer the questions at the end of the chapter.
ASSIGNMENT
LESSON
24
149
DRAFT
PART FOUR
Injuries
Lesson 25: Soft Tissue Injuries I, 151 Lesson 26: Soft Tissue Injuries II/Musculoskeletal Injuries I, 159 Lesson 27: Musculoskeletal Injuries II and Splinting, 166 Lesson 28: Injuries to the Head, Neck and Spine, 178 Lesson 29: Injuries to the Chest, Abdomen and Pelvis, 188
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LESSON
DRAFT 25
SOFT TISSUE INJURIES I

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe the difference between a closed and open wound. List the signals of a severe closed wound. List six main types of open wounds. Describe how to care for closed and open wounds. List the signals of an infected wound. Describe how to prevent infection in an open wound.

To complete this lesson and meet the lesson objectives, you must: Explain the structures involved in soft tissue injuries. Dene a wound. Identify the simplest type of closed wound, including how to care for it. Discuss the six main types of open wounds, including how to care for each type. Identify the signals of an infected wound. Review measures to prevent a wound from becoming infected.

LCD projector, screen and computer Participants textbook Course Presentation: Part Four, Soft Tissue Injuries I Examples of dressings and bandages (optional)
LESSON
25
Soft Tissue Injuries I
151
DRAFT TOPIC:
INTRODUCTION

Time: 3 minutes
The soft tissues include the layers of skin (epidermis, dermis and hypodermis) as well as the fat and muscle that protect the underlying body structures. Soft tissue injuries can affect only the outer layer of skin or all of the layers skin, including the underlying fat and muscle. Most soft tissue injuries are minor, affecting only the outer layers of the skin, and will require little attention. However, some soft tissue injuries, such as those resulting from non-penetrating or penetrating forces, may be severe or life-threatening and require immediate medical attention. A wound is any physical injury involving the soft tissues. Wounds can be classified as closed or open. In closed wounds, the skins surface is not broken; tissue damage and any bleeding occur below the surface. In an open wound, the skin surface is broken and blood may come through the break in the skin. As a lay responder, you need to recognize and care for the various types of soft tissue injuries.
Instructors Note: Soft tissue injuries involving the muscles are discussed in the next lesson.
TOPIC:
CLOSED WOUNDS

Time: 8 minutes
DISCUSSION PRESENTATION: CLOSED WOUNDS
A bruise or contusion is the simplest type of closed wound. Bruises develop when the body is subjected to a blunt force. This results in damage to soft tissue layers and vessels beneath the skin, causing internal bleeding. When blood and other fluids seep into the surrounding tissues, the area becomes discolored and swells. The amount of discoloration and swelling varies depending on the severity of the injury. A significant violent force can cause injuries involving larger blood vessels and deeper layers of muscle tissue, and damage to internal organs. These injuries can result in severe bleeding beneath the skin that may become life-threatening.
SIGNALS OF A SEVERE CLOSED WOUND

DISCUSSION PRESENTATION: SIGNALS OF A SEVERE CLOSED WOUND
Signals of a severe closed wound involving severe internal bleeding include: Tender, swollen, bruised or hard areas of the body, such as the abdomen. Rapid breathing. Skin that feels cool or moist or looks pale or bluish. Vomiting blood or coughing up blood. Excessive thirst. An injured extremity that is blue or extremely pale. Altered mental state, such as the person becoming confused, faint, drowsy or unconscious.
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CARE FOR CLOSED WOUNDS
DISCUSSION PRESENTATION: CARE FOR CLOSED WOUNDS

Many closed wounds are minor and do not require special medical care. Applying cold, however, can be effective early on in helping control both pain and swelling. When applying cold, fill a plastic bag with ice and water or wrap ice in a wet cloth and apply it to the injured area for periods of about 20 minutes. Place a thin towel as a barrier between the ice and the bare skin. If continued icing is needed, remove the pack for 20 minutes, and then reapply it. If the person is not able to tolerate a 20-minute application, limit the application to 10 minutes. Elevate the injured part to help reduce swelling, but do not elevate it if doing so causes the person more pain or if you suspect a dislocation or fracture. Do not assume that all closed wounds are minor injuries. Call 9-1-1 or the local emergency number immediately if: A person complains of severe pain or cannot move a body part without pain. You think the force that caused the injury was great enough to cause serious damage. An injured extremity is blue or extremely pale. The persons abdomen is tender and distended. The person is vomiting blood or coughing up blood. The person shows signals of shock or becomes confused, drowsy or unconscious. Help the person rest in the most comfortable position and keep the person from getting chilled or overheated. Comfort and reassure the person.
TOPIC:
OPEN WOUNDS

Time: 10 minutes
DISCUSSION PRESENTATION: OPEN WOUNDS
The break in the skin of an open wound can be as minor as a scrape of the surface layers or as severe as a deep penetration. The amount of bleeding depends on the location and severity of the injury. The six main types of open wounds are abrasions, lacerations, avulsions, amputations, punctures/penetrations and crush injuries.
ABRASIONS
DISCUSSION PRESENTATION: ABRASIONS

An abrasion is the most common type of open wound. It is also sometimes called a scrape, a road rash or a strawberry. An abrasion is characterized by skin that has been rubbed or scraped away. An abrasion is usually painful because scraping of the outer skin layers exposes sensitive nerve endings. Bleeding is not severe and is easily controlled. Dirt and germs frequently have been rubbed into this type of wound, which is why it is important to clean and irrigate an abrasion thoroughly.
LACERATIONS
DISCUSSION PRESENTATION: LACERATIONS

A laceration is a cut with either jagged or smooth edges, commonly from a sharp-edged object. A laceration can also result when a blunt force splits the skin, often in areas where bone lies directly underneath the skins surface.
LESSON
25
153
DRAFT
LACERATIONS Continued

Deep lacerations can also affect the layers of adipose and muscle, damaging nerves and blood vessels. Lacerations usually bleed freely and can bleed heavily depending on the injury. Lacerations are not always painful and can easily become infected if not cared for properly.
AVULSIONS
DISCUSSION PRESENTATION: AVULSIONS

An avulsion is a serious injury in which a portion of the skin and sometimes other soft tissue is partially or completely torn away. Bleeding is usually significant because avulsions often involve deeper soft tissue layers.
AMPUTATIONS
DISCUSSION PRESENTATION: AM PUTATIONS

An amputation occurs when a body part is severed. Damage to the tissue is severe, but bleeding is usually not as bad as expected. The blood vessels usually constrict and retract at the point of injury slowing the bleeding and making it relatively easy to control with direct pressure. With todays medical technology, reattachment of severed body parts is sometimes possible, making it important to carefully handle and send the severed body part to the hospital with the person.
PUNCTURES/PENETRATIONS
DISCUSSION PRESENTATION: PUNCTURES/ PENETRATIONS
A puncture/penetration wound results when the skin is pierced with a pointed object, such as a nail, piece of glass, splinter, bullet or knife. A gunshot wound is also a puncture wound. The skin usually closes around the penetrating object, and external bleeding is generally not severe. Internal bleeding can be severe if the penetrating object damages major blood vessels or internal organs. When the object remains in the wound, it is referred to as an embedded object; an object may also pass completely through a body part, creating two open wounds an entrance and an exit wound. Puncture wounds are more likely to become infected. Objects penetrating the soft tissues carry microorganisms that cause infections. Of particular danger is the microorganism that causes tetanus, a severe infection.
CRUSH INJURIES
DISCUSSION PRESENTATION: CRUSH INJURIES

A crush injury is the result of a body part, usually an extremity, being subjected to a high degree of pressure, such as being compressed between two heavy objects. This type of injury may be open or closed. Crush injuries may result in serious damage to underlying tissues and cause bleeding, bruising, fracture, laceration and compartment syndrome, which is swelling and an increase in pressure within a limited space that presses on and compromises blood vessels, nerves and tendons that run through that space. In a severe crush injury to the torso, internal organs may rupture. Crush syndrome is also common in people who are trapped in collapsed structures. The injury does not happen at the time that the tissue is crushed, but once the crushed muscle is released from compression and the tissue is perfused with blood. The person may suffer major shock and renal failure and death may occur.
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DRAFT TOPIC:
CARE FOR OPEN WOUNDS

Time: 15 minutes
DISCUSSION PRESENTATION: CARE FOR OPEN WOUNDS
All open wounds need some type of covering to help control bleeding and prevent infection. Theses coverings are commonly referred to as dressings and bandages. Dressings are pads placed directly on a wound to absorb blood and other fluids and to prevent infection. Dressings should be sterile when possible to prevent infection. An occlusive dressing is a bandage or dressing that closes a wound or damaged area of the body and prevents it from being exposed to the air or water. Preventing exposure to the air helps prevent infection. Occlusive dressings also help keep in heat, body fluids and moisture. A bandage is any material that is used to wrap or cover any part of the body. Bandages are used to: Hold dressings in place. Apply pressure to control bleeding. Protect a wound from dirt and infection. Provide support to an injured limb or body part. Any bandage applied snugly to create pressure on a wound or injury is called a pressure bandage. Commonly used bandages include commercially-made adhesive compresses or adhesive bandages, bandage compresses, roller bandages and elastic roller bandages. A roller bandage, which is usually made of gauze-like material of various widths and lengths, is generally wrapped around the body part and tied or taped in place. When applying a roller bandage, follow these general guidelines: Check for feeling, warmth and color of the area distal (below) the injury site, especially fingers and toes, before and after applying the bandage. Secure the end of the bandage in place with a turn of the bandage. Wrap the bandage around the body part until the dressing is completely covered and the bandage extends several inches beyond the dressing. Tie or tape the bandage in place. Do not cover fingers or toes so that you can see if fingers or toes become cold or begin to turn pale, blue or ashen. If so, the bandage is too tight and should be loosened slightly. If blood soaks through the bandage, apply additional dressings and another bandage. Do not remove the blood-soaked bandages and dressings. Elastic roller bandages, also called elastic wraps, are designed to keep continuous pressure on a body part. When properly applied, an elastic bandage can effectively control swelling or support an injured limb. To apply an elastic roller bandage: Check for feeling, warmth and color of the area distal (below) the injury site, especially fingers and toes before and after applying the bandage. Place the end of the bandage against the skin and use overlapping turns. Gently stretch the bandage as you continue wrapping. The wrap should cover a long body section, like an arm or a calf, beginning at the point farthest from the heart. For a joint like a knee or an ankle, use figure-eight turns to support the joint. Tape the end of the bandage in place. Check the snugness of the bandaginga finger should easily, but not loosely, pass under the bandage.
LESSON
25
155
DRAFT
CARE FOR OPEN WOUNDS Continued
Instructors Note: If time allows and samples are available, show participants the different types of dressings and bandages that they may need to use. It can be difficult to judge when an open wound requires stitches. If you are caring for a wound and think it may need stitches, it probably does. A general rule of thumb is that stitches are needed when the edges of skin do not fall together, when the laceration involves the face or when any wound is over inch long. The following major injuries often need stitches: Bleeding from an artery or bleeding that is difficult to control Deep cuts or avulsions that show the muscle or bone, involve joints, such as the elbows, gape widely or involve the hands, feet or face Large punctures Large embedded objects Some human and animal bites Wounds that, if left unattended, could leave a conspicuous scar, such as those that involve the lip or eyebrow.
CARE FOR MINOR OPEN WOUNDS

DISCUSSION PRESENTATION: CARE FOR M INOR OPEN WOUNDS

In minor open wounds, such as an abrasion, damage is only superficial and bleeding is normally minimal. To care for a minor open wound, follow these general guidelines: Use a barrier between your hand and the wound; put on disposable gloves and place a sterile dressing over the wound. Apply direct pressure for a few minutes to control any bleeding. Wash the wound thoroughly with soap and water and gently dry with clean gauze. If possible, irrigate an abrasion for 5 minutes with clean, warm, running tap water. Cover the wound with a clean dressing and a bandage (or with an adhesive bandage) to keep the wound moist and prevent drying. Apply an antibiotic ointment to the dressing or bandage first if the person has no known allergies or sensitivities to the medication. Wash your hands immediately after giving care, even if you wore gloves.
CARE FOR MAJOR OPEN WOUNDS

DISCUSSION PRESENTATION: CARE FOR MAJOR OPEN WOUNDS

A major open wound may have severe bleeding, deep or extensive destruction of tissue or a deeply embedded or impaled object. To care for a major open wound, follow these general guidelines: Call 9-1-1 or the local emergency number. Put on disposable gloves. If blood has the potential to splatter, you may need to wear eye and face protection. Control external bleeding using the general steps learned previously: Cover the wound with a dressing and press firmly against the wound with a gloved hand until the bleeding stops. Apply a pressure bandage over the dressing to maintain pressure on the wound and to hold the dressing in place. If blood soaks through the bandage, do not remove the blood-soaked bandages. Instead, add more pads and bandages to help absorb the blood and continue to apply direct pressure.
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DRAFT
CARE FOR MAJOR OPEN WOUNDS Continued
Continue to monitor the persons condition. Observe the person closely for signals that may indicate that the persons condition is worsening, for example, faster or slower breathing, changes in skin color and restlessness. Take steps to minimize shock. Keep the person from getting chilled or overheated. Have the person rest comfortably and reassure him or her. Wash your hands immediately after giving care, even if you wore gloves. If the person has an amputation: Call 9-1-1 or the local emergency number. Put on disposable gloves. After controlling external bleeding, locate and care for the severed body part: Wrap the severed body part in sterile gauze or any clean material, such as a washcloth; moisten the cloth with sterile saline if available. Place the wrapped part in a plastic bag or container making sure to label it with the persons name and time and date it was placed in the bag. Keep the bag cool by placing it in either a larger bag or container of an ice and water slurry. Do not place the bag on ice alone or on dry ice. Make sure the bag or container is transported to the medical facility by EMS with the person. If the person has an embedded or impaled object in the wound: Call 9-1-1 or the local emergency number if you have not already done so. Put on disposable gloves. Do not remove the object. Apply direct pressure with sterile dressing to the edges of the wound; avoid placing pressure on or moving the object. Use a bulky dressing to stabilize the object. Control bleeding by bandaging the dressing in place around the object. Wash your hands immediately after giving care. If there is a splinter embedded in the skin, it can be removed with tweezers. Then, wash the area with soap and water and rinse the area with tap water for about 5 minutes. After drying the area, cover it with a dressing and bandage to keep it clean. Apply an antibiotic ointment to the dressing first if the person has no known allergies or sensitivities to the medication. If the splinter is embedded in the eye, do not attempt to remove it. Call 9-1-1 or the local emergency number.
LESSON
25
157
DRAFT TOPIC:
INFECTION

Time: 6 minutes
DISCUSSION PRESENTATION: INFECTION
Any break in the skin can provide an entry point for microorganisms that can cause infection. Even a small, seemingly minor laceration or abrasion has the potential to become infected. An infection can range from merely unpleasant to life threatening. Tetanus is a particularly dangerous infection caused by bacteria that produce a powerful poison in the body. In most cases, tetanus can now be successfully treated with antitoxins. A person who has an open wound should also be advised to check with his or her health care provider about the need to update his or her tetanus immunization. The best initial defense against infection is to clean the area. Signals of infection include the following: The area around the wound becomes swollen and red. The area may feel warm or throb with pain. Some wounds have a pus discharge. More serious infections may cause a person to develop a fever and feel ill. Red streaks may develop that progress from the wound in the direction of the heart. If you see any signals of infection: Keep the area clean, soak it in clean, warm water and apply an antibiotic ointment to the wound covering if the person has no known allergies or sensitivities to the medication. Change coverings over the wound daily. If a fever or red streaks develop, the infection is worsening; a health care provider should be contacted to determine what additional care is necessary.
TOPIC:
CLOSING
Time: 3 minutes
DISCUSSION
Caring for wounds involves a few simple steps: Control pain and swelling. Control bleeding. Minimize the risk of infection. With minor closed wounds, applying cold can be effective early on in helping control both pain and swelling. If you suspect the person has a major closed wound (severe internal bleeding), call 9-1-1 or the local emergency number immediately. With minor open wounds, the primary concern is to clean the wound to prevent infection. With major open wounds, you should control bleeding quickly and seek medical attention. Always wear disposable gloves or use a barrier, such as plastic wrap, dressings or a clean folded cloth, to avoid contact with blood. Dressings and bandages, when correctly applied, help control bleeding, reduce pain and minimize the danger of infection. Answer participants questions. Review Chapter 10. Read Chapter 11 and complete the questions at the end of the chapters.
ACTIVITY ASSIGNMENT
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Instructors Manual
LESSON
DRAFT 26
SOFT TISSUE INJURIES II/ MUSCULOSKELETAL INJURIES I

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe how burns are classied. Describe the signals of the different types of burns. Describe how to care for heat (thermal), chemical, electrical and radiation burns. Identify three types of forces that can act upon the body and how these forces can lead to injury. Identify four basic types of musculoskeletal injuries. List the signals of a serious musculoskeletal injury. Describe the general care for musculoskeletal injuries.

To complete this lesson and meet the lesson objectives, you must: Describe the three classications of burns. List the elements that suggest a critical burn. Discuss the care required for each type of burn. Describe how direct, indirect, twisting and contraction lead to musculoskeletal injuries. Discuss fractures, dislocations, sprains and strains as the four basic types of musculoskeletal injury. List the signals of a serious musculoskeletal injury. Show the video segment, Injuries to Muscles, Bones and Joints. Explain the acronym, RICE, as the general care for musculoskeletal injuries.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD LCD projector, screen and computer Participants textbook Course Presentation: Part Four, Soft Tissue Injuries II/Musculoskeletal Injuries I
LESSON
26
Soft Tissue Injuries II/Musculoskeletal Injuries I
159
DRAFT TOPIC:
INTRODUCTION

Time: 3 minutes
Burns are a special kind of soft tissue injury caused by exposure to heat, chemicals, electricity or radiation. Burns can damage the top layer of skin or the skin and layers of adipose, muscle and bone beneath. The severity of a burn depends on: The temperature of the source of the burn. The length of exposure to the source. The location of the burn. The extent of the burn. The persons age and medical condition. The musculoskeletal system is made up of muscles and bones that form the skeleton, as well as connective tissues, tendons and ligaments. Injuries to the musculoskeletal system are common. Although musculoskeletal injuries are almost always painful, they are rarely life threatening when cared for properly.
TOPIC:
BURNS

Time: 10 minutes
DISCUSSION PRESENTATION: BURNS
Burns caused by exposure to heat are the most common. Burns are classified by depth; the deeper the burn, the more severe it is. The three classifications include: Superficial burns (first-degree). Partial-thickness (second degree). Full-thickness (third degree). Burns are also classified by their source: heat or thermal, chemical, electrical or radiation, such as from the sun.
SIGNALS OF BURNS
DISCUSSION PRESENTATION: SIGNALS OF BURNS

Superficial burns involve only the top layer of the skin. The skin is red and dry and the area may swell. Pain is usually present. This type of burn usually heals within a week without permanent scarring. Partial-thickness burns involve the top layers of skin, the epidermis and dermis. Injuries may look red and have blisters, which can open and weep clear fluid. Burned skin may look mottled (blotched) and often swells. Pain is usually present. The burn usually heals in 3 to 4 weeks and may scar. Full-thickness burns may destroy all layers of the skin and some or all of the underlying structures, such as fat, muscle, bone and nerves. The skin may be brown or black (charred) with underlying tissues sometimes appearing white. They can be extremely painful or relatively painless if the burn destroyed nerve endings in the skin. Healing requires medical assistance and scarring is likely.
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DRAFT
CRITICAL BURNS
DISCUSSION PRESENTATION: CRITICAL BURNS

A critical burn requires immediate medical attention. This type of burn is potentially life threatening, disfiguring and disabling. Knowing when to call 9-1-1 or the local emergency number for a burn is difficult. Call 9-1-1 or the local emergency number immediately if the person has: Trouble breathing. Burns covering more than one body part or a large surface area. Suspected burns to the airway, such as burns around the mouth and nose. Burns to the head, face, neck, hands, feet or genitals. Partial- or full-thickness burns and is younger than age 5 or older than age 60. Burn resulting from chemicals, explosions or electricity.
TOPIC:
CARE FOR BURNS
Time: 15 minutes
CARE FOR HEAT (THERMAL) BURNS

DISCUSSION PRESENTATION: CARE FOR HEAT (THERMAL) BURNS
When caring for a heat burn: CHECK the scene for safety. Stop the burning by removing the person from the source of the burn. CHECK for life-threatening conditions. As soon as possible, cool the burn with large amounts of cold running water, at least until pain is relieved. Do not use ice or ice water. Cover the burn loosely with a sterile dressing. Take steps to minimize shock. Keep the person from getting chilled or overheated. Comfort and reassure the person. When the burn is cool, remove all clothing from the area, but do not remove any clothing that is sticking to the skin. There are certain things it is important not to do when caring for a heat burn. Do not touch a burn with anything except a clean covering. Do not try to clean a severe burn. Do not put ointments, butter, oil or other commercial or home remedies on blisters, deep burns or burns that may require medical attention. Do not break blisters. Intact skin helps prevent infection. For small superficial burns that are not sufficiently severe or extensive enough to require medical attention, care for the burned area as an open wound.
CARE FOR CHEMICAL BURNS

DISCUSSION PRESENTATION: CARE FOR CHEM ICAL BURNS
Typically burns result from chemicals that are strong acids or alkalis. Signals of a chemical burn include: Pain. Burning. Numbness. Change in level of consciousness (LOC). Respiratory distress. Oral discomfort or swelling. Eye discomfort. Change in vision.
LESSON
26
161
DRAFT
CARE FOR CHEMICAL BURNS Continued
The stronger the chemical and the longer the contact, the more severe the burn. You must remove the chemical from the body as quickly and safely as possible and call 9-1-1 or the local emergency number. To care for a chemical burn: If the chemical is dry or in a powdered form, brush the chemical from the skin with a gloved hand or a towel and remove any contaminated clothing. Flush the burn with large amounts of cool running tap water (under pressure), continuing to flush the burn for at least 20 minutes or until EMS personnel arrive. Take steps to minimize shock. If an eye is burned by a chemical: Flush the affected eye with water for at least 20 minutes until EMS personnel arrive, tilting the head so that the affected eye is lower than the unaffected eye, flushing from the nose outward. If both eyes are affected, direct the flow to the bridge of the nose and flush both eyes from the inner corner outward. Chemicals can be inhaled, potentially damaging the airway or lungs. Call 9-1-1 or the local emergency number if you believe chemicals have been inhaled and give that information to the call taker.
CARE FOR ELECTRICAL BURNS

DISCUSSION PRESENTATION: CARE FOR ELECTRICAL BURNS

The human body, when in contact with an electrical source, conducts the electricity through the body. Electrical resistance of body parts produces heat, which can cause burn injuries. Electrical burns are often deep. Although the wounds may look superficial, tissues below may be severely damaged. Electrical injuries also cause other problems, such as erratic beating of the heart and fractured bones due to strong muscle spasms. Signals of electrical injury include: Unconsciousness. Dazed, confused behavior. Obvious burns on the skins surface. Trouble breathing or no breathing. Burns both where the current entered and where it exited the body, often on the hand or foot. To care for a person with an electrical injury: Make sure the scene is safe. Never go near a person until you are sure he or she is not still in contact with the power source. If possible, turn off the power at its source and care for any life-threatening emergencies. If you cannot safely turn power off at its source, call 9-1-1 or the local emergency number and wait for advanced help to arrive. Call 9-1-1 or the local emergency number. Any person who has suffered an electrical shock needs to be evaluated by a medical professional to determine the extent of the injury. Remember that electrocution can cause cardiac and breathing emergencies. Be prepared to perform CPR or use an automated external defibrillator (AED). Care for shock and thermal burns. Look for entry and exit wounds and give appropriate care. Check for additional injuries, such as fractures, because the resistance to the electrical current.
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CARE FOR RADIATION BURNS
DISCUSSION PRESENTATION: CARE FOR RADIATION BURNS

Radiation burns may occur from exposure to nuclear radiation, X-rays, or as a side effect of radiation therapy. They can also be caused by tanning beds or as the result of solar radiation from the sun. Solar burns are similar to heat burns; they are usually mild but can be painful. Care for sunburn as you would any other heat burn: Cool the burn and protect the burned area from further damage by keeping it away from the sun. Do not break blisters. Intact skin helps prevent infection.
TOPIC:
MUSCULOSKELETAL INJURIES
Time: 15 minutes
DISCUSSION
PRESENTATION: M USCULOSKELETAL INJURIES
Injuries to the musculoskeletal system are most commonly caused when force is applied to muscles, bones and joints. The three basic causes of musculoskeletal injury are: A direct force that causes injury at the point of impact and can be blunt or penetrating. An indirect force that transmits energy through the body, causing injury away from the point of impact. Twisting force, or rotating force, that causes injury when one part of the body remains still while the rest of the body is twisted or turned away from it.
Instructors Note: Refer participants to Chapter 4 of the textbook for a review of the musculoskeletal system anatomy.
TYPES OF MUSCULOSKELETAL INJURIES

DISCUSSION
PRESENTATION: TYPES OF M USCULOSKELETAL INJURIES
The four basic types of musculoskeletal injuries are: fractures, dislocations, sprains and strains. Fracture is a break or disruption in bone tissue. Fractures are commonly caused by direct, indirect or strong twisting forces. Fractures are classified as open or closed. Open fractures occur when the skin over the fracture site is broken. Closed fractures leave the skin unbroken and are more common than open fractures. Dislocation is a displacement or separation of a bone from its normal position at a joint. As with a fracture, dislocation can be caused by severe direct, indirect or twisting force. Shoulder or finger joints dislocate easily because they are relatively exposed and not protected by ligaments. Sprain is partial or complete tearing or stretching of ligaments and other tissues at a joint usually when the bones that form a joint are forced beyond their normal or usual range of motion. Strain is a stretching and tearing of muscle fibers or tendons. A strain is sometimes called a muscle pull or tear. Strains often result from overexertion, such as lifting something too heavy or working a muscle too hard. They can also result from sudden or uncoordinated movement.
LESSON
26
163
DRAFT
SIGNALS OF MUSCULOSKELETAL INJURIES
DISCUSSION PRESENTATION: SIGNALS OF M USCULOSKELETAL INJURIES
Always suspect a serious injury when any of the following signals are present: A snapping sound is heard. There is pain, which is one of the most common signals in any muscle, bone, or joint injury. The injured area may be very painful to touch or move. There is significant bruising and swelling. There is significant deformity. The area may be twisted or strangely bent. It may have abnormal lumps, ridges and hollows. The person is unable to move or use the affected part normally. Bone fragments protrude from a wound. Person feels bones grating. The injured area is cold, numb and tingly. Cause of the injury, such as a fall or vehicle crash, suggests the injury may be severe.
CARE FOR MUSCULOSKELETAL INJURIES

VIDEO PRESENTATION: INJURIES TO M USCLES, BONES AND JOINTS DISCUSSION PRESENTATION: CARE FOR M USCULOSKELETAL INJURIES
Show the video segment, Injuries to Muscles, Bones and Joints (1:41 minutes).
Call 9-1-1 or the local emergency number for a musculoskeletal injury if: There is obvious deformity. There is moderate or severe swelling and discoloration. Bones sound or feel like they are rubbing together. A snap or pop was heard or felt at the time of the injury. There is a fracture with an open wound at the injury site, or there is bone piercing through the injury site. The injured person cannot move or use the affected part normally. The injured area is cold and numb. The injury involves the head, neck or spine. The injured person has trouble breathing. The cause of the injury suggests that the injury may be severe. It is not possible to safely or comfortably move the person to a vehicle for transport to a hospital. In general, care for musculoskeletal injuries includes following the mnemonic device: RICE, which stands for rest, immobilize, cold and elevate. Rest the injured body part. Avoid any movements or activities that cause pain. Do not move or straighten the injured area. Help the person find the most comfortable position. If you suspect injuries to the head, neck or spine, use manual stabilization, a technique that involves using your hands to support the persons head and neck in the position you found the person without moving or aligning the bodyunless the airway is compromised.
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DRAFT
CARE FOR MUSCULOSKELETAL INJURIES Continued
Immobilize the injured part (keep it from moving) before giving additional care to: Lessen pain. Prevent further damage to soft tissues. Reduce the risk of serious bleeding. Reduce the possibility of loss of circulation to the injured part. Prevent closed fractures from becoming open fractures. A splint should be used only if a person must be moved or transported by non-professional emergency personnel to a medical facility for treatment. If using a splint, follow these four basic principles: Splint ONLY if you have to move the injured person and can do so without causing more pain and discomfort to the person. Splint an injury in the position in which you find it. Do not move, straighten or bend the injured part. Splint the injured area and the joints or bones above and below the injury site. Check for proper circulation (feeling, warmth and color) before and after splinting. Apply cold, which helps reduce swelling and ease pain and discomfort. Use a plastic bag filled with ice and water, ice wrapped in a damp cloth, a large bag of frozen vegetables, such as peas or a commercial cold pack. Place a layer of gauze or cloth between the source of cold and the skin to prevent damage to the skin. Leave ice (or cold pack) on the person for no longer than 20 minutes. If continued icing is needed, remove the ice pack for 20 minutes and then reapply a new ice pack for an additional 20 minutes. If 20 minutes cannot be tolerated, apply ice for periods of 10 minutes. Do not apply a cold pack to an open fracture. Instead, place ice packs around the site. Elevate the injured area above the level of the heart to help slow the flow of blood, reducing swelling. Elevate an injured part only if it does not cause the person more pain. Do not attempt to elevate a seriously injured area of a limb unless it has been immobilized.
TOPIC:
CLOSING

Time: 3 minutes
DISCUSSION
Burns damage the layers of the skin and sometimes the internal structures as well. Heat, chemicals, electricity and radiation all cause burns. When caring for a person with burns, always first ensure your personal safety. When the scene is safe, approach the person, then check for life-threatening conditions and non-life-threatening conditions if necessary. Sometimes, it is difficult to tell if a musculoskeletal injury is a fracture, dislocation, sprain or strain. Always care for the musculoskeletal injury as if it were serious. Answer participants questions. Read Chapter 12 and complete the questions at the end of the chapters. Review Chapter 12 Skill Sheets: Applying an Anatomic Splint, Applying a Soft Splint, Applying a Rigid Splint, and Applying a Sling and Binder.
ACTIVITY ASSIGNMENT
LESSON
26
165
LESSON
27
DRAFT
MUSCULOSKELETAL INJURIES II AND SPLINTING

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe how to care for injuries to the shoulder, upper arm and elbow. Describe how to care for injuries to the forearm, wrist and hand. List three specic signals of a fractured femur. Describe how to care for injuries to the femur, lower leg and knee. Describe how to care for injuries to the ankle and foot. Describe the reasons for immobilizing an injury to an extremity. List the general guidelines for splinting. After completing the skill sessions, participants should be able to: Demonstrate how to effectively immobilize an injured extremity by using an anatomic, soft and rigid splint. Demonstrate how to effectively immobilize an upper extremity injury by using a sling and binder.

To complete this lesson and meet the lesson objectives, you must: Discuss the common types of injuries occurring in the upper extremities and care to be given. Review the common types of injuries occurring in the lower extremities and the care to be given. Identify the signals indicating a fractured thigh bone. Emphasize the importance of immobilizing the injured body part. Briey review the reasons for immobilizing an injury. Show the video segment, Splinting. Discuss the general care and principles associated with splinting an injured body part. Conduct the skill sessions for immobilizing extremity injuries: applying an anatomic, soft or rigid splint, and applying a sling and binder. Emphasize the importance of immobilizing the injured body part.

Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD DVD player and monitor Participants textbook Course Presentation: Part Four, Musculoskeletal Injuries II and Splinting Participant Progress Log (Appendix E or Instructors Corner) LCD projector, screen and computer Skill Charts: Applying an Anatomic Splint, Applying a Soft Splint, Applying a Rigid Splint, and Applying a Sling and Binder Skill Assessment Tools: Applying an Anatomic Splint, Applying a Soft Splint, Applying a Rigid Splint, and Applying a Sling and Binder Nonlatex disposable gloves (multiple sizes) Blankets or pillows Triangular bandages Rigid splints
Instructors Manual | Responding to Emergencies: Comprehensive First Aid/CPR/AED
166
DRAFT TOPIC:
INTRODUCTION

Time: 1 minute
Injuries to an extremity can range from a simple bruise to a dangerous or severely painful injury, such as a fracture of the femur (thigh bone). Prompt care can help prevent further pain, damage, and a life long disability. If you suspect a serious musculoskeletal injury, you must immobilize the injured part before giving additional care to: Lessen pain. Prevent further damage to soft tissues. Reduce the risk of serious bleeding. Reduce the possibility of loss of circulation to the injured part. Prevent closed fractures from becoming open fractures.
TOPIC:
INJURIES TO THE EXTREMITIES
Time: 2 minutes
SIGNALS OF SERIOUS EXTREMITY INJURIES

DISCUSSION PRESENTATION: INJURIES TO EXTREM ITIES
Injuries to the extremities can affect the soft tissues, resulting in open or closed wounds; or affect the musculoskeletal system, resulting in sprains, strains, fractures or dislocations. Signals of a serious extremity injury include: Pain or tenderness. Swelling. Discoloration. Deformity of the limb. Inability to move or use the limb. Severe external bleeding. Loss of sensation or feeling, or tingling. A limb that is cold to the touch.
TOPIC:
UPPER EXTREMITY INJURIES

Time: 10 minutes
DISCUSSION PRESENTATION: UPPER EXTREM ITY INJURIES
The upper extremity is from the shoulder to the fingers. The upper extremities are the most commonly injured areas of the body. Care for all upper extremity injuries includes: Do not move or straighten the injured area. Stabilize the injury in the position found. Allow the person to continue to support the upper extremity in the position in which he or she is holding it. Control any external bleeding with direct pressure unless the bleeding is located directly over a suspected fracture, in which case apply pressure around the area. Always wear disposable gloves or use another protective barrier. If the person is holding the upper extremity away from the body, use a pillow, rolled blanket or similar object to fill the gap between the upper extremity and the chest to provide support to the injured area.
LESSON
27
Musculoskeletal Injuries II and Splinting
167
DRAFT
UPPER EXTREMITY INJURIES Continued
If you must move or transport the person, and it does not cause the person more pain, splint the upper extremity as appropriate for the injury. Apply ice or a cold pack. Take steps to minimize shock.
SHOULDER INJURIES
DISCUSSION PRESENTATION: SHOULDER INJURIES

The most common shoulder injuries are sprains. Injuries to the shoulder may also involve a fracture or dislocation of one more of the bones. The clavicle is the most frequently injured shoulder bone, typically from a fall. The person usually feels pain in the shoulder area, which may radiate down the upper extremity. A person with a clavicle injury usually attempts to ease the pain by holding the arm against the chest. To fracture the scapula takes a violent force, so fractures to this area are not common. Because it takes great force to fracture the scapula, you should look for additional injuries to the head, neck, spine or chest cavity. The most significant signals of a fractured scapula are extreme pain and the inability to move the shoulder. Dislocation of the shoulder joint is another common type of shoulder injury. Like fractures, dislocations often result from falls or direct blows when the arm is in the throwing position. Shoulder dislocations are painful and can often be identified by deformity. As with other shoulder injuries, the person often tries to minimize the pain by holding the upper extremity in the most comfortable position.
CARE FOR SHOULDER INJURIES

DISCUSSION PRESENTATION: CARE FOR SHOULDER INJURIES

Follow the care steps described for upper extremities. If you must move or transport the person, and it does not cause the person more pain, place the upper extremity in a sling and bind it to the chest with cravats (sling and binder) to further stabilize the injury.
UPPER ARM INJURIES

DISCUSSION PRESENTATION: UPPER ARM INJURIES

The upper arm is the upper extremity from the shoulder to the elbow. The humerus is the longest bone in the arm. It can be fractured at any point, although it is usually fractured at the upper end near the shoulder or in the middle of the bone. Most humerus fractures are very painful and the person will most likely not be able to use the injured arm. A humerus fracture can also cause considerable deformity.
CARE FOR UPPER ARM INJURIES

DISCUSSION PRESENTATION: CARE FOR UPPER ARM INJURIES

Follow the care steps described for upper extremities. If you must transport or move the person, and it does not cause more pain, splint an upper arm using a padded rigid splint on the outside of the arm. If the elbow can be comfortably bent, place the upper extremity in a sling and binder to further stabilize the injury. If the elbow cannot be bent, or the rigid splint you are using is longer than the upper arm, keep the arm straight at the persons side and wrap bandages or binders around the arm and chest.
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DRAFT
ELBOW INJURIES
DISCUSSION PRESENTATION: ELBOW INJURIES

The elbow is a joint formed by the humerus and the two bones of the forearm, the radius and the ulna. Injuries to the elbow can cause permanent disability, because all the nerves and blood vessels to the forearm and hand go through the elbow. Therefore, treat elbow injuries seriously. Like other joints, the elbow can be sprained, fractured or dislocated. An injured elbow may either be bent or straight.
CARE FOR ELBOW INJURIES

DISCUSSION PRESENTATION: CARE FOR ELBOW INJURIES

Follow the care steps described for upper extremities. If you must transport or move the person, and it does not cause more pain, splint the arm from the shoulder to the wrist in the best way possible in the position you find it. If the elbow is bent, even if it is deformed, splint with a sling and binder. If the elbow is straight, immobilize the elbow with rigid splints along the length of both sides of the arm, from the fingertips to the underarm.
FOREARM, WRIST AND HAND INJURIES

DISCUSSION PRESENTATION: FOREARM, WRIST AND HAND INJURIES

The forearm is the area between the elbow and the wrist. The wrist is a joint formed by the hand and forearm. Injuries to the wrist may involve one or both of the two forearm bonesthe radius and ulna. When both forearm bones fracture, the arm may look s-shaped. Because the radial artery and nerves are close to these bones, a fracture may cause severe bleeding or a loss of movement in the wrist or hand. The hand consists of many small bonesthe carpals, metacarpals and phalanges. The wrist is a common site of sprains and fractures. Most injuries to the hands and fingers involve minor soft tissue damage. However, a serious injury may damage nerves, blood vessels and bones and can significantly impact a persons daily activities.
CARE FOR FOREARM, WRIST AND HAND INJURIES

DISCUSSION PRESENTATION: CARE FOR FOREARM, WRIST AND HAND INJURIES

Follow the care steps described for upper extremities. If you must transport or move the person, and it does not cause the person more pain: Support an injured forearm or wrist by placing a rigid splint underneath the forearm, from the elbow to the fingertips. A sling and binder can then be applied to support the arm against the chest. If a single finger is injured, you may be able to create an anatomic splint by taping the injured finger to the one beside it. You can also improvise a rigid splint by taping the injured area to a small object, such as an ice cream stick or tongue depressor. For several broken fingers, or when the back of the hand is involved, place a rolled up bandage or small ball in the palm of the persons hand with the fingers naturally curled around it, then wrap the entire hand and splint the lower arm and wrist with a rigid splint. A sling can be added to help support the arm.
LESSON
27
169
DRAFT TOPIC:
LOWER EXTREMITY INJURIES
Time: 10 minutes
DISCUSSION PRESENTATION: LOWER EXTREM ITY INJURIES
Injuries to the leg, or lower extremitythe part of the body from the hip (pelvis) to the toescan involve both soft tissue and musculoskeletal damage.
THIGH INJURIES
DISCUSSION PRESENTATION: THIGH INJURIES

The thigh is the lower extremity from the pelvis to the knee. The thigh contains the femur, the largest bone in the body. The femoral arteries are the major suppliers of blood to the lower extremities. When the femur is fractured, the blood vessels and nerves may be damaged. If a femoral artery is damaged, the blood loss can be life threatening. Thigh injuries range from bruises and torn muscles to severe injuries, such as fractures or hip or knee dislocations. Most femur fractures involve the upper end of the bone where the femur meets the pelvis at the hip joint. When the femur is broken near the hip joint, it is commonly called a fractured hip. Signals of a fractured femur include the following: Deformity The injured leg will be noticeably shorter than the non-injured limb. The injured leg may also be turned outward. Severe pain Inability to move the lower extremity Do not attempt to splint a suspected femur fracture (this requires special training and equipment).
CARE FOR THIGH INJURIES

DISCUSSION PRESENTATION: CARE FOR THIGH INJURIES

Because a fractured femur is a serious life-threatening injury that requires immediate medical attention, call 9-1-1 or the local emergency number immediately. While waiting for EMS personnel to arrive: Stabilize the injury in the position found. Help the person rest in the most comfortable position. Apply ice or a cold pack. Take steps to minimize shock, remembering that a fractured femur can result in serious internal bleeding and the likelihood of shock is considerable. Keep the person lying down and try to keep him or her calm. Keep the person from becoming chilled or overheated. Monitor the persons breathing and general condition. Watch for changes in the persons level of consciousness.
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DRAFT
KNEE INJURIES
DISCUSSION PRESENTATION: KNEE INJURIES

The knee comprises the lower end of the femur, the upper ends of the tibia and fibula and the patella, and is highly vulnerable to injury. The patella is a free-floating bone that moves on the lower front surface of the thigh bone. Sprains, fractures and dislocations are especially common in athletic activities that involve quick movements or exert unusual force on the knee. Deep lacerations around the area of the knee can cause severe joint infections. The patella is very vulnerable to bruises, lacerations and dislocations. Violent forces to the front of the knee can fracture the kneecap or cause a dislocation of the knee or hips.
CARE FOR KNEE INJURIES

DISCUSSION PRESENTATION: CARE FOR KNEE INJURIES
Do not move or straighten the injured area. Stabilize the injury in the position found. If the knee is bent, you can support it on a pillow or folded blanket in the bent position. If the knee is on the ground, the ground will provide adequate support. Control any external bleeding with direct pressure unless the bleeding is located directly over a suspected fracture. If so, apply pressure around the area. Always wear disposable gloves or use another protective barrier. Call 9-1-1 or the local emergency number. If you must transport or move the person, and it does not cause more pain: Use padded rigid splints running around either side of the knee to immobilize the knee. If the knee is straight, use two padded rigid splints of either side of the affected leg. The inside splint should start at the groin and extend past the bottom of the foot. The outside splint should start at the hip and also extend past the foot. Cravats will help keep the splint in place. If the knee is straight, you might also splint by securing the injured knee to the uninjured leg, as you would do for a lower leg injury. Apply ice or a cold pack. Take steps to minimize shock.
LOWER LEG INJURIES

DISCUSSION PRESENTATION: LOWER LEG INJURIES

The lower leg is the area between the knee and the ankle. The tibia and fibula are the two bones in the lower leg. A fracture in the lower leg may involve the tibia, the fibula or both. Sometimes, both bones are fractured simultaneously. A blow to the outside of the lower leg can cause an isolated fracture of the smaller bone (fibula). Lower leg fractures may cause a severe deformity in which the lower leg is bent at an unusual angle (angulated), as well as pain and inability to move the leg.
CARE FOR LOWER LEG INJURIES

DISCUSSION PRESENTATION: CARE FOR LOWER LEG INJURIES

Do not move or straighten the injured area. Stabilize the injury in the position found. Control any external bleeding with direct pressure unless the bleeding is located directly over a suspected fracture. If so, apply pressure around the area. Always wear disposable gloves or use another protective barrier.
LESSON
27
171
DRAFT
CARE FOR LOWER LEG INJURIES Continued

Call 9-1-1 or the local emergency number immediately. If you must transport or move the person, and it does not cause the person more pain, you can create an anatomic splint by securing the injured lower extremity to the uninjured lower extremity with several wide cravats placed above and below the site of the injury. If one is available, place a pillow or rolled blanket between the lower extremities and bind them together above and below the site of the injury. Apply ice or a cold pack. Take steps to minimize shock.
ANKLE AND FOOT INJURIES

DISCUSSION PRESENTATION: ANKLE AND FOOT INJURIES

The foot consists of many small bonesthe tarsals, metatarsals and phalanges. The ankle is a joint formed by the foot and the lower leg. Ankle and foot injuries are commonly caused by twisting forces and can range from minor sprains with little swelling and pain to fractures and dislocations. Fractures of the feet and ankles can occur from forcefully landing on the heel. This transmitted force of the impact may also be transmitted up the lower extremities, resulting in an injury elsewhere in the body. Foot injuries may also involve the toes. Although toe injuries are painful, they are rarely serious.
CARE FOR ANKLE AND FOOT INJURIES

DISCUSSION PRESENTATION: CARE FOR ANKLE AND FOOT INJURIES

Do not move or straighten the injured area. Stabilize the injury in the position found. Control any external bleeding with direct pressure unless the bleeding is located directly over a suspected fracture. If so, apply pressure around the area. Always wear disposable gloves or use another protective barrier. If you must transport or move the person, and it does not cause more pain, immobilize the entire foot and ankle by using a soft splint, such as a pillow or rolled blanket. Wrap the injured area with the soft splint and secure it with two or three cravats. Apply ice or a cold pack. Take steps to minimize shock.
TOPIC:
IMMOBILIZING EXTREMITY INJURIES

Show the video segment, Splinting (5:07 minutes).
Time: 20 minutes
VIDEO PRESENTATION: SPLINTING
SPLINTING
DISCUSSION PRESENTATION: SPLINTING
No matter where the splint will be applied, or what the injury is, follow these general rules in addition to those in the video: Cut off or remove any clothing around the injury site. If the person is wearing a watch or jewelry near the injury, remove it as swelling may occur beyond the actual injury site. Cover any bleeding or open wounds, including open fractures, with sterile dressings and carefully bandage with minimal pressure before splinting.
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SPLINTING Continued
Do not try to push protruding bones back below the skin. Do not attempt to straighten any angulated fracture; always splint the limb in the position found. Do not allow the person to bear weight on an injured lower extremity. Pad the splints you are using so that they will be more comfortable and conform to the shape of the injured body part. Secure the splint in place with cravats, roller bandages or other wide strips of cloth. Avoid securing the splint directly over an open wound or the injury. Elevate the splinted part if doing so does not cause the person discomfort. After the injury has been immobilized, apply cold to the injured area, help the person rest in the most comfortable position, reassure him or her, and take steps to minimize shock. Things not to do when applying splints include: Do not apply ice or a cold pack directly over an open fracture, because doing so would require you to put pressure on the open fracture site and could cause discomfort to the person. Do not apply heat; there is no evidence that applying heat helps. Remind participants that splinting is required only if you have to move or transport the person and if you can do so without causing additional pain. Ask the participants to take the textbook to the practice area. Tell participants that they will be using the skill sheets in Chapter 12 of the textbook. Assign partners or ask the participants to find a partner. Have each participant practice one skill with his or her partner as the injured person. Guide the participants through the skills for applying an anatomic, soft and rigid splint. Give help when appropriate or when requested. After participants have completed the skill, have them change places. Guide the participants through a different splinting skill. Give help when appropriate or when requested. Ensure that the partners do not repeat the same skill, so that both participants do two different skills through practice and observation. Record the participants successful completion on the Participant Progress Log (Appendix E or Instructors Corner) after skills have been performed. Answer participants questions. Ask the participants to take the textbook to the practice area. Tell participants that they will be using the skill sheet in Chapter 12 of the textbook. Assign partners or ask the participants to find a partner. Have each participant practice the skill with his or her partner as the injured person. Guide the participants through the skill for applying a sling and binder. Give help when appropriate or when requested. After participants have completed the skill, have them change places. Record the participants successful completion on the Participant Progress Log (Appendix E or Instructors Corner) after the skill has been performed. Answer participants questions.
SKILL SESSION: IMMOBILIZING EXTREMITY INJU RIES: APPLYING AN ANATOMIC, SOFT AND RIGID SPLINT
SKILL SESSION: APPLYING A SLING AND BINDER
LESSON
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173
DRAFT TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Caring for musculoskeletal and soft tissue injuries to the extremities focuses on minimizing pain, shock and further damage to the injured area. Remember: it is not always possible to distinguish between minor and severe injuries. Injuries to the pelvis and femur are potentially critical because of the major blood vessels running through these parts of the body. In addition, a force strong enough to cause injury to an extremity may also have been strong enough to cause other injuries. With any injury to an extremity, first, care for any life-threatening conditions and call 9-1-1 or the local emergency number if necessary. Then provide care as needed. Answer participants questions. Read Chapter 13 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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SKILL CHART: APPLYING AN ANATOMIC SPLINT
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured person: 1. Get consent. 2. Support the injured body part above and below the site of the injury. 3. Check for feeling, warmth and color beyond the injury. 4. Position bandages. Place several folded triangular bandages above and below the injured body part. 5. Align body parts. Place the uninjured body part next to the injured body part. 6. Tie bandages securely. 7. Recheck circulation. Recheck for feeling, warmth and color. Tip: If you are not able to check warmth and color because a sock or shoe is in place, check for feeling.
SKILL ASSESSMENT TOOL: APPLYING AN ANATOMIC SPLINT

Criteria Immobilize the injured part. Proficient Secures splint with sufficient tension to prevent injured part from moving more than 1 inch from splinted position Secures splint without causing skin to discolor or become cool to touch, or creating a tingling sensation beyond the injury Not Proficient Secures splint with insufficient tensioninjured part can move more than 1 inch from splinted position Secures splint causing skin to discolor Secures splint causing skin to become cool to touch Secures splint creating a tingling sensation beyond the injury
Make sure that the splint is not too tight.
SKILL CHART: APPLYING A SOFT SPLINT

In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured person: 1. Get consent. 2. Support the injured part. Support both above and below the site of the injury. 3. Check circulation. Check for feeling, warmth and color beyond the injury. 4. Position bandages. Place several folded triangular bandages above and below the injured body part. 5. Wrap with a soft object. Gently wrap a soft object (e.g., a folded blanket or pillow) around the injured body part. 6. Tie bandages securely. 7. Recheck circulation for feeling, warmth and color. Tip: If you are not able to check warmth and color because a sock or shoe is in place, check for feeling.
SKILL ASSESSMENT TOOL: APPLYING A SOFT SPLINT

Criteria Immobilize the injured part. Proficient Secures splint with sufficient tension to prevent injured part from moving more than 1 inch from splinted position Not Proficient Secures splint with insufficient tensioninjured part can move more than 1 inch from splinted position
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SKILL ASSESSMENT TOOL: APPLYING A SOFT SPLINT Continued
Make sure that the splint is not too tight. Secures splint without causing skin to discolor or become cool to touch, or creating a tingling sensation beyond the injury Secures splint causing skin to discolor Secures splint causing skin to become cool to touch Secures splint creating a tingling sensation beyond the injury
SKILL CHART: APPLYING A RIGID SPLINT

In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criteria below at the proficient level to be checked off for this skill. After checking the scene and the injured person: 1. Get consent. 2. Support the injured part. Support both above and below the site of the injury. 3. Check circulation. Check for feeling, warmth and color beyond the injury. 4. Place splint. Place an appropriately sized rigid splint (e.g., padded board) under the injured body part. Tip: Place padding such as roller gauze under the palm of the hand to keep it in a neutral position. 5. Secure bandages. Tie several folded triangular bandages above and below the injured body part. 6. Recheck for feeling, warmth and color. Tip: If a rigid splint is used on an injured forearm, immobilize the wrist and elbow. Bind the arm to the chest with folded triangular bandages or apply a sling. If a rigid splint is used on an injured joint, immobilize the bones on either side of the joint.
SKILL ASSESSMENT TOOL: APPLYING A RIGID SPLINT

Criteria Immobilize the injured part. Proficient Secures splint with sufficient tension to prevent injured part from moving more than 1 inch from splinted position Secures splint without causing skin to discolor or become cool to touch, or creating a tingling sensation beyond the injury Not Proficient Secures splint with insufficient tensioninjured part can move more than 1 inch from splinted position Secures splint causing skin to discolor Secures splint causing skin to become cool to touch Secures splint creating a tingling sensation beyond the injury
Make sure that the splint is not too tight.
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SKILL CHART: APPLYING A SLING AND BINDER
In addition to performing the steps listed in this skill chart in the correct order, participants must meet the criterion below at the proficient level to be checked off for this skill. After checking the scene and the injured person: 1. Get consent. 2. Support the injured body part above and below the site of the injury. 3. Check circulation. Check for feeling, warmth and color beyond the injury. 4. Position sling. Place a triangular bandage under the injured arm and over the uninjured shoulder to form a sling. 5. Secure sling. Tie the ends of the sling at the side of the neck. Tip: Pad the knots at the neck and side of the binder for comfort. 6. 7. Bind with bandage. Bind the injured body part to the chest with a folded triangular bandage. Recheck circulation. Recheck for feeling, warmth and color.
SKILL ASSESSMENT TOOL: APPLYING A SLING AND BINDER

Criterion Immobilize the injured part. Proficient Secures splint with sufficient tension to prevent injured part from moving more than 1 inch from splinted position Not Proficient Secures splint with insufficient tensioninjured part can move more than 1 inch from splinted position
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LESSON
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DRAFT
INJURIES TO THE HEAD, NECK AND SPINE

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify the most common causes of head, neck and spinal injuries. List 10 situations that might indicate serious head, neck and spinal injuries. List the signals of head, neck and spinal injuries. Describe how to effectively minimize movement of the persons head, neck and spine. Know the situations in which you would hold the persons head in the position found. Describe how to care for specic injuries to the head, face, neck and lower back. Know how to prevent head, neck and spinal injuries.

To complete this lesson and meet the lesson objectives, you must: Briey review the common causes of head, neck and spinal injuries, including situations that might suggest such injuries. Identify the signals of head, neck and spinal injuries. Discuss the care to be given when a person sustains a head, neck or spinal injury, emphasizing situations that require maintaining a persons head in the position found. Conduct the activity for using manual stabilization. Identify ways to prevention head, neck and spinal injuries.

LCD projector, screen and computer Participants textbook Course Presentation: Part Four, Injuries to the Head, Neck and Spine
TOPIC:
INTRODUCTION

Time: 2 minutes
Each year, nearly 2 million Americans suffer a head, neck or spinal injury serious enough to require medical care. Most of those injured are males between the ages of 15 and 30. Motor vehicle collisions account for nearly half of all head, neck and spinal cord injuries. Other causes include falls, injuries from sports and recreational activities and violent acts, such as assault. Besides those who die each year in the United States because of head, neck or spinal injury, nearly 800,000 become permanently disabled. Prompt, appropriate care can help minimize damage from most head, neck and spinal injuries.
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DRAFT TOPIC:
RECOGNIZING AND CARING FOR SERIOUS HEAD, NECK AND SPINAL INJURIES

Time: 20 minutes
DISCUSSION PRESENTATION: SERIOUS HEAD, NECK AND SPINAL INJURIES
Injuries to the head, neck or spine often damage both bone and soft tissue, including brain tissue and the spinal cord. It is usually difficult to determine the extent of damage in head, neck and spinal injuries, so treat all such injuries as serious.
Instructors Note: Refer participants to Chapter 13 of the textbook to review the anatomy of the head, brain, face, neck, back and spine. Explain that you will not review this material in this class but recommend that they should review this material on their own.
CHECKING THE SCENE

DISCUSSION PRESENTATION: CHECKING THE SCENE

Evaluate the scene for clues as to whether a head, neck or spinal injury may have occurred during the CHECK phase of the emergency action steps. Think about the forces involved in the injury. Strong forces are likely to cause severe injury to the head, neck and spine. Consider the possibility of a serious head, neck or spinal injury if the injured person: Is unconscious. Was involved in a motor vehicle crash or subjected to another significant force. Was injured as a result of a fall from greater than the persons standing height. Is wearing a safety helmet that is broken. Complains of neck or back pain. Has tingling or weakness in the extremities. Is not fully alert. Appears to be intoxicated. Appears to be frail or older than 65 years. Is a child younger than 3 years with evidence of a head or neck injury. Approach the person from the front so he or she can see you without turning his or her head, and tell the person to respond verbally to your questions. Ask the responsive person the following questions, while maintaining manual stabilization, to further assess the situation: Does your neck or back hurt? What happened? Where does it hurt? Can you move your hands and feet? Can you feel where I am touching?
SIGNALS OF SERIOUS HEAD, NECK OR SPINAL INJURIES

DISCUSSION PRESENTATION: SIGNALS OF SERIOUS HEAD, NECK OR SPINAL INJURIES
When checking a person with a suspected head, neck or spinal injury, look for any swollen or bruised areas, but do not put direct pressure on any area that is swollen, depressed or soft. Look for certain signals that indicate a serious injury including: Changes in the level of consciousness. Severe pain or pressure in the head, neck or spine. Tingling or loss of sensation in the extremities. Partial or complete loss of movement of any body part.
LESSON
28
Injuries to the Head, Neck and Spine
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DRAFT
SIGNALS OF SERIOUS HEAD, NECK OR SPINAL INJURIES Continued
Unusual bumps or depressions on the head or neck. Sudden loss of memory. Blood or other fluids in the ears or nose. Profuse external bleeding of the head, neck or back. Seizures in a person who does not have a seizure disorder. Impaired breathing or impaired vision as a result of injury. Nausea or vomiting. Persistent headache. Loss of balance. Bruising of the head, especially around the eyes or behind the ears. These signals may be obvious or develop later. Alone, these signals do not always suggest a serious head, neck or spinal injury, but they may when combined with the cause of the injury. Regardless, always call 9-1-1 or the local emergency number when you suspect a serious head, neck or spinal injury.
CARE FOR HEAD, NECK OR SPINAL INJURIES

DISCUSSION PRESENTATION: CARE FOR HEAD, NECK OR SPINAL INJURIES

Head, neck and spinal injuries can become life-threatening emergencies and cause a person to stop breathing. It is essential to maintain an open airway. Call 9-1-1 or the local emergency number. While waiting for EMS personnel to arrive, give the following care: Use manual stabilization to minimize movement of the head, neck and spine. Because excessive movement of the head, neck or spine can damage the spinal cord irreversibly, keep the person as still as possible until EMS personnel arrive and take over. If the person is wearing a helmet, do not remove it unless you are specifically trained to do so and it is necessary to assess or access the persons airway. Minimize movement using the same manual stabilization technique you would use if the person was not wearing headgear. Check for life-threatening conditions. Maintain an open airway. Monitor consciousness and breathing. Control any external bleeding with direct pressure unless the bleeding is located directly over a suspected fracture. Do not apply direct pressure if there are any signs of an obvious skull fracture. Wear disposable gloves or use another barrier. Do not attempt to remove a penetrating object; rather stabilize it with a bulky dressing. Take steps to minimize shock. Keep the person from becoming chilled or over heated. To perform manual stabilization and help prevent further damage to the spinal column: Place your hands on both sides of the persons head in the position in which you found it. Gently support the persons head in that position until EMS personnel arrive and take over. Try to keep the person from moving his or her lower body, since this movement will change the position of the head and neck. Do not attempt to align the head and lower body. If the head is sharply turned to one side, do not move it. Support it in the position found. Manual stabilization can be performed on persons who are lying down, sitting or standing.
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CARE FOR HEAD, NECK OR SPINAL INJURIES Continued
If you are unable to maintain an open airway, or if you have to leave to get help or an AED, place the person in a modified H.A.IN.E.S. recovery position. Use two people in order to maintain manual stabilization and minimize movement of the persons head, neck and spine. Ask another responder to help move the persons body while you maintain manual stabilization. Assign partners or ask the participants to select a partner. One person acts as the responder; the other acts as the injured person. Ask the participants and their partners to practice the proper positioning of an injured person by using manual stabilization. Have the participants act as seated injured persons involved in a vehicle collision. Have the responders stabilize the persons head and neck, either from behind, beside or in front of the injured person. After the participants have practiced the skill to the point that they feel comfortable with their ability to perform it, have them change places. Repeat the practice. Answer participants questions.
ACTIVITY
CHECK FOR LIFE-THREATENING CONDITIONS

DISCUSSION PRESENTATION: CHECK FOR LIFETHREATENING CONDITIONS
You do not always have to put a person onto his or her back to check breathing. A cry of pain, chest movement as a result of inhaling and exhaling or the sound of breathing tells you the person is breathing, so you do not need to move him or her to check. If the person is breathing, support him or her in the position in which you found him or her. If the person is not breathing or you cannot tell, roll the person gently onto his or her back, but avoid twisting the spine. Carefully tilt the head and lift the chin just enough to open the airway, or give rescue breaths if needed. If the person begins to vomit, carefully roll him or her into the modified H.A.IN.E.S. recovery position to keep the airway clear.
MONITOR CONSCIOUSNESS AND BREATHING

DISCUSSION
PRESENTATION: MONITOR CONSCIOUSNESS AND BREATHING
Observe the persons level of consciousness and breathing while stabilizing the head because a serious injury can result in changes in consciousness. Injury to the head or neck can paralyze chest nerves and muscles, causing breathing to stop. If breathing stops, give CPR immediately.
CONTROL EXTERNAL BLEEDING

DISCUSSION PRESENTATION: CONTROL EXTERNAL BLEEDING
If the person is bleeding externally, control it promptly with dressings, direct pressure and bandages. Many blood vessels are located in the head, and two major arteries and the jugular vein are located in the neck, possibly leading to a significant loss of blood if injury occurs. Do not apply pressure to both carotid arteries simultaneously, and do not put a bandage around the neck.
MINIMIZE SHOCK
DISCUSSION PRESENTATION: M INIM IZE SHOCK

A serious injury to the head or spine can disrupt the bodys normal heating or cooling mechanism, leaving the person more susceptible to shock. Take steps to minimize shock by keeping the person from becoming chilled or overheated.
LESSON
28
181
DRAFT TOPIC:
SPECIFIC INJURIES
Time: 20 minutes
DISCUSSION PRESENTATION: SPECIFIC INJURIES
The brain is easily injured because it lacks the padding of muscle and fat found in other areas of the body.
CONCUSSION
DISCUSSION PRESENTATION: CONCUSSION

A concussion is a type of brain injury that involves a temporary loss of brain function resulting from a blow to the head. A person with a concussion may not always lose consciousness. The effects of a concussion can appear immediately or very soon after the blow to the head. Some effects do not appear for hours or even days and may last for several days or even longer. Signals of a concussion include: Confusion, which may last from moments to several minutes. Headache. Repeated questioning about what happened. Temporary memory loss, especially for periods immediately before and after the injury. Brief loss of consciousness. Nausea and vomiting. Speech problems (person is unable to answer questions or obey simple commands). Blurred vision or light sensitivity. Treat every suspected concussion seriously. Always call 9-1-1 or the local emergency number. While waiting for help to arrive, give care as follows: Support the head and neck in the position in which you found it. Maintain an open airway. Control any bleeding and apply dressings to any open wounds. Do not apply direct pressure if there are any signs of an obvious skull fracture. If there is clear fluid leaking from the ears or a wound in the scalp, cover the area loosely with a sterile gauze dressing. Monitor the person for any changes in condition. Try to comfort and reassure the person. Encourage the person to talk with you to help keep the person calm.
SCALP INJURIES
DISCUSSION PRESENTATION: SCALP INJURIES

Bleeding from scalp injuries can be minor or severe. Even minor lacerations can bleed heavily because the scalp contains many blood vessels. If the person has an open wound to the scalp, control the bleeding with direct pressure: Apply several dressings and hold them in place with your gloved hand. If gloves are not available, use a protective barrier. Press gently at first because the skull may be fractured. If you feel a depression, spongy area or bone fragments, avoid direct pressure and attempt to control bleeding with pressure on the area around the wound. Secure the dressings with a roller bandage or triangular bandage. Call 9-1-1 or the local emergency number if you are unsure about the extent of the injury.
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CHEEK INJURIES
DISCUSSION PRESENTATION: CHEEK INJURIES

Injury to the cheek usually involves only soft tissue. You may have to control bleeding on either the outside, inside or both sides of the cheek. If the person swallows enough blood, nausea or vomiting can result, thus complicating the situation. Begin care by examining both the outside and inside of the cheek. To control bleeding inside the cheek, place several dressings, folded or rolled, inside the mouth, against the cheek. If there is external bleeding, place dressings on the outside of the cheek and apply direct pressure. If an object passes completely through the cheek and becomes embedded, and you cannot control bleeding with the object in place, the object should be removed so that you can control bleeding and keep the airway clear. This circumstance is the only exception to the general rule not to remove embedded objects from the body. Remove the object by pulling it out in the same direction it entered. Fold or roll several dressings and place them inside the mouth. Also, apply dressings to the outside of the cheek. Do not obstruct the airway. Place the person in a seated position leaning slightly forward so that blood will not drain into the throat. Call 9-1-1 or the local emergency number.
NOSE INJURIES
DISCUSSION PRESENTATION: NOSE INJURIES

Nose injuries are usually caused by a blow from a blunt object resulting in a nosebleed. A broken nose may be deformed and will swell. High blood pressure, changes in altitude or dry air can also cause nosebleeds. To control a nose bleed: Have the person sit with his or her head slightly forward while pinching the nostrils together for about 10 minutes. If pinching the nostrils together does not control the bleeding, you can try applying an ice pack to the bridge of the nose. Or, put pressure on the upper lip just beneath the nose. Keep the person leaning slightly forward so that blood does not drain into the throat and make the person vomit. If you think an object is in the nose, do not try to remove it as special lighting and instruments are required. Instead, reassure the person and call for more advanced medical care. Seek additional medical care if the nosebleed continues after using these techniques, bleeding recurs or the person says the bleeding is the result of high blood pressure. If the person loses consciousness, place the person in the modified H.A.IN.E.S. recovery position. Call 9-1-1 or the local emergency number immediately.
LESSON
28
183
DRAFT
EYE INJURIES
DISCUSSION PRESENTATION: EYE INJURIES

Injuries to the eye can involve the bone and soft tissue surrounding the eye or the eyeball. Blunt objects may injure the eye area, or a smaller object may penetrate the eyeball. Injuries that penetrate the eyeball are very serious and can cause blindness. Foreign bodies that get in the eye are irritating and can cause significant damage. Pain from irritation is often severe. The person may have difficulty opening the eye because light further irritates it. Care for open or closed wounds around the eyeball as you would for any other soft tissue injury. Never put direct pressure on the eyeball. To care for a foreign body in the eye: Have the person blink several times and then gently flush the eye with water to try to remove the foreign body. If the object remains, have the person seek more advanced medical care. Flushing the eye with water is also appropriate if the person has any chemical in the eye. Continuously flush the eye until EMS personnel arrive. If an object is embedded: Place the person in a face-up position and enlist someone to help stabilize the persons head. Do not attempt to remove any object embedded in the eye. Stabilize the object by encircling the eye with a gauze dressing or soft sterile cloth, being careful not to apply any pressure to the area. Position bulky dressings around the impaled object and then cover it with a shield, such as a paper cup. Do not use Styrofoam-type materials because small particles can break off and fall into the eye. Make sure the shield does not touch the object. Bandage the shield and dressing in place with a self-adhering bandage and roller bandage covering the persons injured eye, as well as the uninjured eye, to keep the object stable and minimize movement. Comfort and reassure the person. Do not leave the person unattended.
EAR INJURIES
DISCUSSION PRESENTATION: EAR INJURIES
External injuries to the ear, such as lacerations and abrasions, are common. An avulsion can occur when a pierced earring catches on something and tears away from the ear. Internal injuries also may occur. Foreign objects can become lodged in the ear canal. A direct blow to the head may rupture the eardrum. Sudden pressure changes can also injure the ear internally. Loss of hearing or balance, and inner ear pain may occur. For bleeding from the soft tissues, apply direct pressure to the affected area with a gloved hand or other barrier.
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EAR INJURIES Continued
For a foreign object in the ear: If you can easily see and grasp the object, remove it. Do not try to remove any object by using a pin, toothpick or a similar sharp item. You could force the object farther back or puncture the eardrum. Sometimes, you can remove the object if you pull down on the earlobe, tilt the head to the side and shake or gently strike the head on the affected side. If you cannot easily remove the object, have the person seek more advanced medical care. If a person has a serious head injury, blood or other fluid may be in the ear canal or may be draining from the ear. Do not attempt to stop the drainage with direct pressure. Cover the ear lightly with a sterile dressing and call 9-1-1 or the local emergency number.
MOUTH, JAW AND NECK INJURIES

DISCUSSION PRESENTATION: MOUTH, JAW AND NECK INJURIES

The primary concern for any injury to the mouth, jaw or neck is to ensure that the airway is open. Such injuries may cause trouble breathing if blood or loose teeth obstruct the airway. A soft tissue injury to the neck can produce severe bleeding and swelling that may result in airway obstruction. Because the spine may also be involved, care for a serious neck injury as you would a possible spinal injury. The trachea may be crushed or collapsed, causing an airway obstruction that requires immediate medical attention. If you do not suspect a serious head, neck or spinal injury, place the person in a seated position with the head tilted slightly forward to allow any blood to drain. If this position is not possible, place the person on his or her side to allow blood to drain from the mouth. For injuries that penetrate the lip: Place a rolled dressing between the lip and the gum. You can place another dressing on the outer surface of the lip. Apply a dressing and direct pressure with a gloved hand if the tongue is bleeding. Apply ice or a cold pack to the lips or tongue, which can help reduce swelling and ease pain. The person should seek medical attention if the bleeding cannot be controlled easily. If the injury knocked out one or more of the persons teeth, you will need to control the bleeding and save the tooth or teeth for replantation. If the person is conscious and able to cooperate, rinse out the mouth with cold tap water, if available. Roll a sterile dressing and insert it into the space left by the missing tooth or teeth to control the bleeding. Have the person gently bite down on the dressing to maintain pressure. To save the tooth, carefully pick it up by the crown (not at the root end). Place the tooth in a closed container of milk. If the injury is severe enough to call 9-1-1 or the local emergency number, give the tooth to EMS personnel when they arrive. If the injury is not severe enough to call 9-1-1 or the local emergency number, the person should seek dental or emergency care as soon as possible after the injury. Leave intact dentures in position to support the mouth structure. Remove broken dentures and send them with the person to assist the oral surgeon with jaw alignment.
LESSON
28
185
DRAFT
MOUTH, JAW AND NECK INJURIES Continued
For a suspected jaw fracture or dislocation: Call 9-1-1 or the local emergency number. Maintain an open airway. Check inside the mouth for bleeding and control bleeding as you would for other head injuries. Minimize movement of the head, neck or spine with manual stabilization. For a serious soft-tissue injury to the neck, provide care as you would for a serious spinal injury. Call 9-1-1 or the local emergency number. While waiting for EMS personnel to arrive, try to keep the person from moving, and encourage him or her to breathe slowly. Control any external bleeding with direct pressure, wearing a glove or using another barrier. Do not to apply pressure that constricts both carotid arteries. For a large laceration to the neck, apply an occlusive dressing to avoid the possibility of air getting into a vein.
LOWER BACK INJURIES

DISCUSSION PRESENTATION: LOWER BACK INJURIES

Certain injuries to the neck and back are not life threatening but can be extremely painful and temporarily disabling, and may occur without warning. Using improper lifting techniques when lifting or moving heavy objects is one way to injure the back, or working in a cramped space in a bent-over or awkward position may cause back pain, as can sitting or standing in one position for a long period of time. Often acute back pain that develops suddenly is a result of one of the following causes: Ligament pulls and muscle strain Vertebrae displacement Slipped (prolapsed) disk
SIGNALS OF LOWER BACK INJURIES

DISCUSSION PRESENTATION: SIGNALS OF LOWER BACK INJURIES
Signals of a lower back injury include: Shooting pain in the lower back. Sharp pain in one leg. Sharp pain and tightness across the lower back. A sudden, sharp pain in the back and a feeling that something snapped. Inability to bend over without pain.
CARE FOR LOWER BACK INJURIES

DISCUSSION PRESENTATION: CARE FOR LOWER BACK INJURIES

Call 9-1-1 or the local emergency number immediately if the person has any of the following accompanying signals, which may indicate possible damage to the spinal cord: Numbness or tingling in any extremity Difficulty moving Loss of bladder or bowel control Also call 9-1-1 or the local emergency number immediately if: The person has signals of possible spinal cord damage. The person is an older adult with severe back pain.
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CARE FOR LOWER BACK INJURIES Continued

Initial cold treatment and bed rest along with pain-relieving medications generally provide relief for strains and muscle spasms. Exercises may be recommended to strengthen the back and abdominal muscles.
Instructors Note: Refer participants to Chapter 13 in the textbook for safety measures to prevent head, neck or spinal injuries; review the following measures: Correctly wear safety belts (lap and shoulder restraints) and place children in car safety seats. Correctly wear approved helmets, eyewear, faceguards and mouthguards during activities for which they are recommended. Take steps to prevent falls, such as ensuring hallways and stairways in your home are well lit, and stairways have handrails and non-slip treads. Rugs should be secured with double-sided tape or appropriate mats. Use non-slip mats in the bathtub or use handrails. Always use a stepstool or step ladder to reach objects that are up high. Do not attempt to pull heavy objects that are out of reach over your head. Use good lifting techniques when lifting and carrying heavy objects. Obey rules in sports and recreational activities. Avoid inappropriate use of alcohol and other drugs. Inspect work and recreational equipment periodically. Do not dive into a body of water if you are unsure of the depth. Think and talk about safety and use good common sense.
TOPIC:
CLOSING

Time: 3 minutes
DISCUSSION
Injuries to the head, neck and spine can be serious. Some injuries can only be detected if the persons condition worsens over time. Watch for signals of serious injury that require medical attention. Care for life-threatening emergencies first and then give additional care for specific injuries. Always call 9-1-1 or the local emergency number as soon as possible. For open wounds, control the bleeding. If you suspect a fracture, immobilize the injured part. Answer participants questions. Read Chapter 14 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
LESSON
28
187
LESSON
29
DRAFT
INJURIES TO THE CHEST, ABDOMEN AND PELVIS

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Explain why injuries to the chest, abdomen and pelvis can be fatal. List the signals of chest injury. Describe how to care for rib fractures. Describe how to care for a sucking chest wound. List the signals of abdominal and pelvic injuries. Describe the care for open and closed abdominal and pelvic injuries. Describe how to care for injuries to the genitals.

To complete this lesson and meet the lesson objectives, you must: Explain that the location of many vital organs in the chest, abdomen and pelvis makes injury to these areas possibly fatal. Identify the signals indicating a chest injury. Explain the care of a person with fractured ribs and a sucking chest wound. Review the signals indicating abdominal and pelvic injuries. Discuss the care required for open and closed abdominal and pelvic injuries and injuries to the genitals.

LCD projector, screen and computer Participants textbook Course Presentation: Part Four, Injuries to the Chest, Abdomen and Pelvis
TOPIC:
INTRODUCTION

Time: 2 minutes
Many injuries to the chest, abdomen and pelvis involve only soft tissues. These injures are often only minor cuts, scrapes, burns and bruises. A violent force or mechanism, known as trauma, results in more severe injuries, including fractures and injuries to organs that cause severe bleeding or impair breathing. Fractures and lacerations often occur in motor vehicle collisions to occupants not wearing seat belts. Falls, sports mishaps and other forms of trauma may also cause such injuries.
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DRAFT TOPIC:
INJURIES TO CHEST, ABDOMEN AND PELVIS

Time: 15 minutes
DISCUSSION PRESENTATION: INJURIES TO CHEST, ABDOM EN AND PELVIS
The chest, abdomen and pelvis contain many organs important to life. Therefore, injury to any of these areas can be fatal. Any force capable of causing severe injury in these areas may also cause injury to the spine. General care for injuries to the chest, abdomen and pelvis includes: Calling 9-1-1 or the local emergency number. Limiting movement. Monitoring breathing and signs of life. Controlling bleeding. Minimizing shock.
CHEST INJURIES
DISCUSSION PRESENTATION: CHEST INJURIES

Chest injuries are the second-leading cause of trauma deaths each year in the United States. These injuries may involve the bones that form the chest cavity or the organs or other structures in the cavity itself. Chest wounds are either open, such as when a knife or bullet penetrates the chest wall, or closed without a break in the skin, usually from striking a blunt object. Signals of a serious chest injury include: Trouble breathing or no breathing. Severe pain at the site of the injury. Flushed, pale, ashen or bluish skin. Obvious deformity, such as that caused by a fracture. Coughing up blood (may be bright red or dark like coffee grounds). Bruising at the site of a blunt injury, such as that caused by a seat belt. A sucking noise or distinct sound when the person breathes.
RIB FRACTURES
DISCUSSION PRESENTATION: RIB FRACTURES

Rib fractures are usually caused by direct force to the chest. A simple rib fracture is rarely life threatening. A person with a fractured rib generally remains calm. Breathing is shallow because normal or deep breathing is painful. Person attempts to ease the pain by supporting the injured area with a hand or arm. If you suspect a fractured rib, follow these care steps: Have the person rest in a position that will make breathing easier. Encourage the person to take deep, slow breaths, if tolerated. Do not move the person if you suspect a head, neck or spinal injury. Call 9-1-1 or the local emergency number. Give the person a blanket or pillow to hold against the fractured ribs to support and immobilize the area. Use a sling and binder to hold the persons arm and/or blanket or pillow against the injured side of the chest. Monitor breathing. Take steps to minimize shock.
LESSON
29
Injuries to the Chest, Abdomen and Pelvis
189
DRAFT
PUNCTURE WOUNDS
DISCUSSION PRESENTATION: PUNCTURE WOUNDS

Puncture wounds to the chest range from minor to life threatening and cause varying degrees of internal or external bleeding. If the injury penetrates the rib cage, air can pass freely in and out of the chest cavity, and the person cannot breathe normally. A sucking sound coming from the wound is noted with each breath. This sound is the primary signal of a penetrating chest injury called a sucking chest wound (although the sound might not be easily heard in a noisy environment). Without proper care, the persons condition will worsen. The affected lung or lungs will fail to function, and breathing will become more difficult. To care for a sucking chest wound: Call 9-1-1 or the local emergency number. Cover the wound with a large occlusive dressing. A piece of plastic wrap or a plastic bag folded several times and placed over the wound makes an effective occlusive dressing. If these materials are not available to use as dressings, use a folded cloth. Tape the dressing in place, except for one side or corner that remains loose. Monitor the persons breathing. Take steps to minimize shock. To care for an impaled object in the chest: Call 9-1-1 or the local emergency number. Do not remove the object, unless it interferes with chest compressions. Stabilize the object to prevent further damage. Remove clothing to expose the wound. Control bleeding by applying direct pressure to the edges of the wound (but avoid placing direct pressure on the object). Use sterile bulky dressing or gauze around the object to hold it in place. Carefully pack the dressing around the object. Secure the sterile bulky dressing in place with gauze, a cravat or tape.
ABDOMINAL INJURIES
DISCUSSION PRESENTATION: ABDOM INAL INJURIES

The abdomen is the area immediately under the chest and above the pelvis. The upper abdomen is partially protected by the lower ribs and spine. The muscles of the back and abdomen also help protect vital internal organs, such as the liver, spleen and stomach, which are easily injured and tend to bleed profusely when injured. Injury to the abdomen may be open or closed. It is especially difficulty to determine if a person has an internal abdominal injury if he or she is unconscious. Always suspect an abdominal injury in a person who has multiple traumas. Signal of serious abdominal injury include: Severe abdominal pain. Bruising. External bleeding. Nausea and vomiting (sometimes vomit contains blood). Pale, or ashen, cool, moist skin. Weakness. Thirst. Pain, tenderness or a tight feeling in the abdomen.
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DRAFT
ABDOMINAL INJURIES Continued
Organs protruding from the abdomen. Rigid abdominal muscles. Other signals of shock. Call 9-1-1 or the local emergency number for any serious abdominal injury. With a severe open injury, abdominal organs sometimes protrude through the wound. To care for an open wound to the abdomen, follow these steps: Put on disposable gloves or use another barrier. Do not apply direct pressure. Do not push any protruding organs back into the open wound. Remove clothing from around the wound. Apply moist, sterile or clean dressings loosely over the wound. (Clean, warm tap water can be used.) Cover dressings loosely with plastic wrap, if available. Cover dressings lightly with a folded towel to maintain warmth. Keep the person from getting chilled or overheated. To care for a closed abdominal injury: Carefully position the person on his or her back with the knees bent, if that position does not cause the person pain. Avoid putting direct pressure. Place rolled-up blankets or pillows, if available, under the persons knees. Shock is likely to occur with any serious abdominal injury; call 9-1-1 or the local emergency number immediately and take steps to minimize shock. To care for an impaled object in the abdomen: Do not remove the object. Dress the wound around the object to control bleeding. Stabilize the object with bulky dressing to prevent movement.
PELVIC INJURIES
DISCUSSION PRESENTATION: PELVIC INJURIES

The pelvis is the lower part of the trunk and contains the bladder, reproductive organs and part of the large intestine, including the rectum. Major arteries (the femoral arteries) and nerves pass through the pelvis. Injuries to the pelvis may include fractures to the pelvic bone and damage to structures within. Fractured bones may puncture or lacerate these structures, or they can be injured when struck by a forceful blow from blunt or penetrating objects. An injury to the pelvis sometimes involves the genitals, which are the external reproductive organs. Genital injuries are either closed wounds, such as a bruise, or open wounds, such as an avulsion or laceration. Any injury to the genitals is extremely painful. Signals of pelvic injury are the same as those for an abdominal injury. Always call 9-1-1 or the local emergency if you suspect a pelvic injury. Because an injury to the pelvis also can involve injury to the lower spine, it is best not to move the person. If possible, try to keep the person lying flat. Watch for signs of internal bleeding and take steps to minimize shock until EMS personnel take over. Any injury to the genitals is extremely painful. Care for a closed wound to the male genitals as you would for any closed wound. Wrap the penis in a soft, sterile dressing moistened with saline solution and apply a cold compress to reduce pain and swelling. Never remove an impaled objectstabilize and bandage it in place.
LESSON
29
Injuries to the Chest, Abdomen and Pelvis
191
DRAFT
PELVIC INJURIES Continued

Injuries to the genital area can be embarrassing for both the person and the responder. Explain briefly what you are going to do and then do it. If the genital injury is an open wound: Apply a sterile dressing and direct pressure with your gloved hand or the persons hand, or use a barrier. If the penis is partially or completely amputated, apply a sterile pressure dressing to help stop bleeding. If any parts are avulsed or completely amputated, wrap them in sterile gauze moistened with sterile saline if available; place them in a plastic bag, labeled with the persons name and the time and date they were placed in the bag. Keep the bag cool by placing it in a larger bag or container of ice and water slurry, not on ice alone and not on dry ice. Transfer the bag to the EMS personnel when they arrive. For an injury affecting the scrotum or testicles, apply an ice pack to the area to reduce swelling and pain. If the scrotal skin has become avulsed, try to find it. Wrap the skin in sterile dressing and transport this with the person. Dress the scrotum with sterile gauze moistened with saline; apply pressure to control bleeding. For an injury to the female genitals: Control bleeding with pressure using compresses moistened with saline. Use a diaper-like dressing for the wound and stabilize any impaled objects with a bandage. Use ice packs over the dressing to reduce swelling and ease pain. Never place anything in the vagina including dressings. Provide privacy by clearing the area of onlookers and draping a sheet or blanket over the person.
TOPIC:
CLOSING

Time: 3 minutes
DISCUSSION
Injuries to the chest, abdomen or pelvis can be serious. Some injuries can only be detected if the persons condition worsens over time. Watch for signals of serious injury that require medical attention. Care for life-threatening emergencies first and then give additional care for specific injuries. Always call 9-1-1 or the local emergency number as soon as possible. For open wounds, control the bleeding. If you suspect a fracture, immobilize the injured part. Use occlusive dressings for sucking chest wounds and open abdominal wounds. Answer participants questions. Read Chapter 15 and complete the questions at the end of the chapters.
ACTIVITY ASSIGNMENT
192
Instructors Manual
DRAFT
PART FIVE
Medical Emergencies
Lesson 30 Sudden Illnesses I, 194 Lesson 31 Sudden Illnesses II/Poisoning, 202 Lesson 32 Sudden Illnesses III/Bites and Stings, 211 Lesson 33 Sudden Illnesses IV/Substance Misuse and Abuse, 221 Lesson 34 Heat-Related Illnesses and Cold-Related Emergencies, 229 Lesson 35 Putting It All Together/Injuries and Sudden Illness, 239
PART FIVE
Medical Emergencies
193
LESSON
30
DRAFT
SUDDEN ILLNESSES I
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Recognize the signals of a sudden illness. List the general guidelines for giving care to a person with a sudden illness. Describe how to care for a person who faints. Describe how to care for a person having a diabetic emergency. Describe how to care for a person having a seizure. Describe how to care for a person having a stroke. Identify ways to reduce the risk of a stroke or transient ischemic attack (TIA).

To complete this lesson and meet the lesson objectives, you must: Emphasize that participants do not need to know the cause of an illness to give care. Show the video segment, Recognizing Sudden Illness. Conduct the activity related to experiencing a sudden illness. Discuss the signals and care for specic sudden illnesses, including fainting, diabetic emergency, seizure and stroke. List ways to reduce the risk for stroke or transient ischemic attack.

DVD player and monitor LCD projector, screen and computer Participants textbook Course Presentation: Part Five, Sudden Illnesses I Newsprint or chalkboard Markers or chalk
TOPIC:
INTRODUCTION

Time: 3 minutes
Some illnesses develop over time, whereas others can strike without a moments notice. By knowing the signals of sudden illness and paying careful attention to details at the emergency scene, you can determine how best to help a person of sudden illness. You do not need to know the exact cause of the illness to give appropriate care. Always follow the emergency action steps: CHECKCALLCARE.
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Instructors Manual
DRAFT TOPIC:
RECOGNIZING AND CARING FOR SUDDEN ILLNESSES
Time: 15 minutes
VIDEO PRESENTATION: RECOGNIZING SUDDEN ILLNESS ACTIVITY
Show the video segment, Recognizing Sudden Illness (8.27 minutes).
Ask participants how many of them have experienced a situation in which someone suddenly became ill. Ask participants to share with the class what happened, how they felt and how they were cared for. Record on newsprint or chalkboard the signals that the persons displayed or described.
SIGNALS OF SUDDEN ILLNESSES

DISCUSSION PRESENTATION: SIGNALS OF SUDDEN ILLNESS
Common signals of sudden illnesses include: Changes in level of consciousness, such as feeling light-headed, dizzy, drowsy or confused, or becoming unconscious. Breathing problems (i.e., trouble breathing or no breathing). Signals of a possible heart attack Signals of a stroke Signals of shock Loss of vision or blurred vision. Sweating. Persistent abdominal pain or pressure. Nausea or vomiting. Diarrhea. Seizures.
CARE FOR SUDDEN ILLNESSES

DISCUSSION PRESENTATION: CARE FOR SUDDEN ILLNESS
Care for sudden illnesses by following the same general guidelines as you would for any emergency. Do no further harm. Monitor the persons level of consciousness and breathing. Help the person to rest in the most comfortable position. Keep the person from getting chilled or overheated. Comfort and reassure the person but do not give false hope. Give any specific care as needed. If the person is conscious, ask if he or she has any medical conditions or is taking any medications. Do not give the person anything to eat or drink unless he or she is fully conscious, able to swallow and does not show any signals of a stroke. If the person vomits and is unconscious and lying down, position the person on his or her side in the modified H.A.IN.E.S. position so you can clear the mouth. Knowing enough about sudden illnesses to recognize when to call 9-1-1 or the local emergency number is your top priority as a lay responder.
LESSON
30
Sudden Illnesses I
195
DRAFT TOPIC:
SPECIFIC SUDDEN ILLNESSES

Time: 25 minutes
DISCUSSION PRESENTATION: SPECIFIC SUDDEN ILLNESSES
Some sudden illnesses may be linked with chronic conditions, such as heart or lung disease. When checking the person, look for a medical identification (ID) tag, bracelet, necklace or anklet indicating that the person has a chronic condition or allergy. You do not need to know the cause to help. Signals for sudden illness are similar to other conditions and the care probably involves skills that you already know.
FAINTING
DISCUSSION PRESENTATION: FAINTING

Fainting (also known as syncope) is a partial or complete loss of consciousness. It is caused by a temporary reduction of blood flow to the brain, such as when blood pools in the legs and lower body. Fainting can be triggered by an emotionally stressful event, such as the sight of blood. It may be caused by pain, specific medications, conditions, standing for long periods of time or overexertion. Fainting may occur with or without warning. Signals of fainting may include: Pale or ashen cool, moist skin. Sweating Loss of consciousness and then collapse. A person who feels light-headed, weak or dizzy may prevent a fainting spell by lying down or sitting with his or her head level with the knees. Fainting is usually a self-correcting condition. When the person collapses, normal circulation to the brain resumes and the person regains consciousness within a minute. Fainting by itself usually does not harm the person, but injury may occur, for example, from falling. If you can reach the person as he or she is starting to collapse, Lower him or her to the ground or other flat surface. Position the person on his or her back, lying flat. Loosen any tight or restrictive clothing the person is wearing. Check that the person is breathing. If the person vomits, roll him or her onto one side. If you are unsure of the persons condition or if moving is painful to the person, keep him or her lying flat. Do not give the person anything to eat or drink. Do not slap the person or splash water on his or her face. As long as the person recovers quickly and has no lasting signals, you may not need to call 9-1-1 or the local emergency number. Call 9-1-1 or the local emergency number if you are in doubt about the persons condition or he or she has sustained an injury as a result of the sudden illness. If you do not call for help, it is always appropriate to have a bystander or family member take the person to a physician or emergency department to determine if the fainting episode is linked to a more serious condition.
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DRAFT
DIABETIC EMERGENCIES
DISCUSSION PRESENTATION: DIABETIC EM ERGENCIES

A total of 23.6 million people in the United States (7.8% of the population) have diabetes. Diabetes is defined as the inability of the body to change sugar (glucose) form food into energy. This process is regulated by insulin, a hormone produced in the pancreas. Diabetes mellitus, or diabetes, is a condition in which the body does not produce enough insulin or does not use insulin effectively. The cells in the body need sugar (glucose) as a source of energy. The cells receive this energy either from digested food or from stored forms of sugar. The sugar is absorbed into the bloodstream with the help of insulin. For the body to function properly, insulin and sugar must be in balance. The two major types of diabetes are: Type 1 diabetes, formerly called juvenile diabetes, affects about 1 million Americans. People with Type I diabetes must inject insulin into their bodies daily because their bodies produces little or no insulin. Type 2 diabetes is the most common type, affecting about 90 to 95 percent of people with diabetes. With Type 2 diabetes, the body produces insulin, but not enough to meet the bodys needs, or the body becomes resistant to the insulin produced. Type 2 diabetes is progressive; people with this type of diabetes eventually may need to use insulin. Anyone who has diabetes must carefully monitor his or her blood glucose levels, diet and exercise. If not controlled, the person can have a diabetic emergency. Hyperglycemia occurs when the insulin level in the body is too low and the sugar level in the blood begins to rise too high. Sugar is present in the blood, but it cannot be transported from the blood into the cells without insulin. Body cells become starved for sugar. The body attempts to meet its need for energy by using other stored food and energy sources, such as fats. Converting fat to energy is less efficient, produces waste products and increases the acidity level in the blood, causing a condition known as diabetic ketoacidosis. A person with diabetic ketoacidosis becomes ill. He or she may have flushed, hot, dry skin and a sweet, fruity breath odor that can be mistaken for the smell of alcohol. The person also may appear restless or agitated. If the condition is not treated promptly, a life-threatening emergency called a diabetic coma can occur. Hypoglycemia occurs when the insulin level in the body is too high and the person has a low blood sugar level. The blood sugar level can become too low if the person takes too much insulin, fails to eat adequately or, due to sudden illness, cannot keep food or liquids down, over exercises and burns off sugar faster than normal, or experiences great emotional stress. In this situation, sugar is used up rapidly, so not enough sugar is available for the brain to function properly. If left untreated, hypoglycemia may result in a life-threatening condition called insulin shock.
LESSON
30
Sudden Illnesses I
197
DRAFT
DIABETIC EMERGENCIES Continued
Although hyperglycemia and hypoglycemia are different conditions, their major signals are similar and include: Changes in the level of consciousness. Changes in mood. Irregular breathing. Feeling or looking ill. Abnormal skin appearance. Dizziness and headache. Confusion. Care for both of these diabetic emergencies is the same. If you know someone experiencing the signals, you may know the person is diabetic. A person who is conscious may also tell you he or she is diabetic. Also look for a medical ID tag, bracelet, necklace or anklet. Often individuals with diabetes know what is wrong and will ask for something with sugar in it or they may carry some form of sugar with them in case they need it. If the person is conscious and able to swallow, and advises you that he or she needs sugar, give sugar in the form of several glucose tablets or glucose paste, a 12-ounce serving of fruit juice, milk, or nondiet soft drink, or table sugar dissolved in a glass of water. If the problem is too much sugar, this amount of sugar will not cause further harm. People with diabetes also may carry glucagon, which they can self-administer to counter hypoglycemia. People who take insulin to control diabetes may have injectable medication with them to care for hyperglycemia. Do not try to assist a person by administering insulin to them. Always call 9-1-1 or the local emergency number if: The person is unconscious or about to lose consciousness. The person is conscious but unable to swallow. The person does not feel better approximately 5 minutes after taking sugar. You cannot find any form of sugar immediately. If the person is unconscious: Do not give him or her anything by mouth. Give care in the same way you would for any unconscious person.
SEIZURES
DISCUSSION PRESENTATION: SEIZURES
When the normal functions of the brain are disrupted by injury, disease, fever, infection, metabolic disturbances or conditions causing a decreased oxygen level, a seizure may occur. A seizure is a result of abnormal electrical activity in the brain and causes temporary involuntary changes in body movement, function, sensation, awareness or behavior. Types of seizures include: Generalized tonic-clonic seizures, also called grand mal seizures that affect both halves of the brain, are characterized by four phases: Aura phase: person senses something unusual Tonic phase: unconsciousness and then muscle rigidity Clonic phase: uncontrollable muscular contractions (convulsions) Post-ictal phase: diminished responsiveness with gradual recovery and confusion
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DRAFT
SEIZURES Continued
Partial seizures affecting only a very small area of one hemisphere of the brain: Simple partial seizures: involuntary muscle contraction in one area of the body; person usually remains aware Complex partial seizures: often with a blank stare followed by random movements such as lip smacking or chewing Absence seizures or petit mal seizures: brief sudden loss of awareness or conscious activity that may be mistaken for daydreaming Febrile seizures: those brought on by a rapid increase in body temperature, most commonly in children under the age of 5 Epilepsy is not a specific disease but a term used to describe a group of disorders in which the individual experiences recurrent seizures as the main symptom. When caring for someone experiencing an epileptic seizure, it is important to protect the person from injury and manage the airway by doing the following: Do not put anything, including your fingers, in the persons mouth. Make sure that the environment is as safe as possible; remove any nearby furniture or other objects that may injure the person. After the seizure passes, position the person on his or her side in a modified H.A.IN.E.S position so that fluids can drain from the mouth. When the seizure is over: Check to see if the person was injured during the seizure. Offer comfort and reassurance. Stay with the person until he or she is fully conscious and aware of the surroundings. Call 9-1-1 or the local emergency number for any of the following situations: The seizure lasts more than 5 minutes or the person has repeated seizures with no signs of slowing down (status epilepticus). The person appears to be injured. You are uncertain about the cause of the seizure. The person is pregnant. The person is known to have diabetes. The person is a child or an infant The seizure takes place in water. The person fails to regain consciousness after the seizure. The person is a young child or an infant who experienced a febrile seizure brought on by a high fever. The person is elderly and could have suffered a stroke. This is the persons first seizure. Status epilepticus is an epileptic seizure or repeated seizures that last longer than 5 minutes without any sign of slowing down. This is a true medical emergency that may be fatal. If you suspect a person is experiencing this type of seizure, call for advanced medical personnel immediately.
LESSON
30
Sudden Illnesses I
199
DRAFT
STROKE
DISCUSSION PRESENTATION: STROKE

A stroke, also called a cerebrovascular accident (CVA) or brain attack, is caused when blood flow to the brain is cut off or when there is bleeding into the brain. It can cause permanent brain damage if not treated appropriately; sometimes, the damage can be stopped or reversed. Stroke is most commonly caused by a blood clot, called a thrombus or embolus, that forms or lodges in the arteries supplying blood to the brain. Another common cause of stroke is bleeding from a ruptured artery in the brain caused by a head injury, high blood pressure or an aneurysm (a weak area in the wall of an artery that balloons out and can rupture). Fat deposits lining an artery (atherosclerosis) may also cause stroke. Less commonly, a tumor or swelling from a head injury may compress an artery and cause a stroke. A transient ischemic attack (TIA), often called a mini-stroke, is a temporary episode that like a stroke is caused by a disruption in blood flow to a part of the brain. However, unlike a stroke, the signals of TIA disappear within a few minutes or hours of its onset. Although the indicators of TIA disappear quickly, the person is not out of danger. Because you cannot distinguish a stroke from a TIA, call 9-1-1 or the local emergency number immediately when any signals appear. The risk factors for stroke are similar to those for heart disease. Some risk factors are beyond your control, such as age, gender, family history of stroke or heart disease. Other risk factors can be controlled through diet, changes in lifestyle or medication. Uncontrolled high blood pressure is the number one risk factor for stroke. Diabetes is another major risk factor. Experiencing a TIA is the clearest warning that stroke may occur. Looking or feeling ill or displaying abnormal behavior are common general signals. Other specific signals have a sudden onset including: Facial droop or drooling. Weakness or numbness of the face, arm or leg, usually on only one side of the body. Trouble with speech, such as trouble talking, getting words out or being understood when speaking and possibly trouble understanding. Loss of vision or disturbed (blurred or dimmed) vision in one or both eyes. The pupils may be of unequal size. Sudden severe headache, often described as the worst headache ever. Dizziness, confusion, agitation, loss of consciousness or other severe altered mental status. Loss of balance or coordination, trouble walking or ringing in the ears. Incontinence. Think FAST for stroke: Face: weakness, numbness, or drooping on one side Arm: weakness or numbness in one arm. Speech: slurred speech or difficulty speaking Time: determination of when signals began. Call 9-1-1 or the local emergency number immediately if you encounter someone who is having or has had a stroke, or if the person had a mini-stroke (even if the signals have gone away).
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DRAFT
STROKE Continued
In addition: Note the time of onset of signals and report it to the emergency medical dispatcher or EMS personnel when they arrive. If the person is unconscious, make sure that he or she has an open airway and care for any life-threatening conditions. If fluid or vomit is in the persons mouth, position him or her in a modified H.A.IN.E.S position. You may have to remove some fluids or vomit from the mouth by using one of your fingers. Stay with the person and monitor his or her breathing and changes in his or her condition. If the person is conscious, check for non-life-threatening conditions. Offer comfort and reassurance as a stroke can make the person fearful and anxious. Often, he or she does not understand what has happened. Have the person rest in a comfortable position. Do not give him or her anything to eat or drink. Although a stroke may cause the person to experience difficulty speaking, he or she can usually understand what you say. If the person is unable to speak, use nonverbal forms of communication, such as hand squeezing or eye blinking, and communicate in forms that require a yes-or-no response (squeeze or blink once for yes, twice for no.)
TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Sudden illness can strike anyone, at any time. Even if you do not know the cause of the illness, you can still give proper care. Knowing the signals of sudden illness, such as changes in consciousness, profuse sweating, confusion and weakness, will help you determine the necessary care to give the person until EMS personnel arrive. Answer participants questions. Read Chapter 16 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
LESSON
30
Sudden Illnesses I
201
LESSON
31
DRAFT
SUDDEN ILLNESSES II/POISONING

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify the general guidelines for care for any poisoning emergency. Understand when to call the Poison Control Center and when to call 9-1-1 or the local emergency number. List the four ways poisons enter the body. Identify the signals of each type of poisoning. Describe how to care for a person based on the type of poisoning. Identify the signals and care of anaphylaxis. List the ways to prevent poisoning.

To complete this lesson and meet the lesson objectives, you must: Dene a poison. Conduct the activity related to the methods by which poisons enter the body. Emphasize the need to check the scene for clues to poisoning. Explain Poison Control Centers (PCCs) as specialized health centers providing information on poisons and suspected poisoning emergencies. Describe that PCCs can help prevent overburdening the EMS system because many poisonings can be treated without the help of EMS personnel. Identify situations in which calling 9-1-1 or the local emergency number is appropriate. Review the signals for each type of poisoning. Discuss the care for a person who has experienced poisoning based on the type of poisoning. Explain anaphylaxis as a severe allergic reaction to poisons. List the signals of anaphylaxis. Describe the care for a person experiencing anaphylaxis. Show the video segment, Assisting with an Epinephrine Auto-Injector. Identify measures to prevent poisoning.

DVD player and monitor LCD projector, screen and computer Participants textbook Course Presentation: Part Five, Sudden Illnesses II/Poisoning Newsprint or chalkboard Markers or chalk Samples of epinephrine auto-injectors, if available
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Instructors Manual
DRAFT TOPIC:
INTRODUCTION

Time: 3 minutes
A poison is any substance that can cause injury, illness or death when introduced into the body. Poisoning can occur by ingesting (swallowing), inhaling (breathing), or absorbing it through the skin, or by having it injected into the body. Poisonings can be accidental or intentional. Many substances that are not poisonous in small amounts are poisonous in larger amounts. Over 93 percent of poisonings take place in the home and 50 percent involved children younger than age 6.
Instructors Note: Whenever possible, check with local hospitals or a Poison Control Center to get statistics on the number and types of poisonings that are common in your particular area.
TOPIC:
ACTIVITY
POISONING
Time: 12 minutes
Ask participants to identify four methods by which poisons enter the body. Record the participants responses on newsprint or chalkboard.
Instructors Note: Responses should include inhalation, ingestion, absorption and injection. Ask for examples of each type of poison. Record these examples on newsprint or chalkboard. Ask participants to explain how different body systems might be affected by different methods of poisoning. Instructors Note: Additional information on ways poisons can enter the body and examples can be found in Chapter 16 in the textbook.
GENERAL CARE FOR POISONING

DISCUSSION PRESENTATION: GENERAL CARE FOR POISONING
The severity of a poisoning depends on: The type and amount of the substance. The time that elapsed since the poison entered the body. The persons size (build), weight, medical condition and age. Look for clues about what has happened. Ask the person or bystanders. Check the scene, being aware of unusual odors, flames, smoke, open or spilled containers, an open medicine cabinet, or overturned or damaged plant. If you think someone has swallowed a poison, try to find out: The type of poison. The quantity taken. When it was taken. How much the person weighs. After checking the scene and determining that there has been a poisoning, follow these general care guidelines: Remove the person from the source of poison if the scene is dangerous. Do this only if you are able to without endangering yourself.
LESSON
31
Sudden Illnesses II/Poisoning
203
DRAFT
GENERAL CARE FOR POISONING Continued
Check the persons level of consciousness and breathing. For life-threatening conditions, such as if the person is unconscious or is not breathing, or if a change in the level of consciousness occurs, call 9-1-1 or the local emergency number immediately. Care for any life-threatening conditions. If the person is conscious, ask questions to get more information. Look for any containers and take them with you to the telephone. Call the National Poison Control Center Hotline at 800-222-1222 and follow any directions they give.
PCCs
DISCUSSION PRESENTATION: PCCs

Poison Control Centers (PCCs) are specialized health centers that provide information on poisons and suspected poisoning emergencies. Since many poisonings can be treated without the help of EMS personnel, PCCs help prevent overburdening of the EMS system. PCCs, which are staffed by pharmacists, physicians, nurses and toxicology specialists, can be reached by calling 800-222-1222. More than 70 percent of poison exposure cases can be managed over the phone. However, you should call 9-1-1 or the local emergency number for a poisoning if you are unsure about what to do or you are unsure about the severity of the problem, or it is a life-threatening condition. In general, call 9-1-1 or the local emergency number instead of the PCC if a person: Is unconscious, confused or seems to be losing consciousness. Has trouble breathing. Has persistent chest pain or pressure. Has pressure or pain in the abdomen that does not go away. Is vomiting blood or passing blood in their stool or urine. Has a seizure, severe headache or slurred speech. Acts aggressively or violently.
TOPIC:
TYPES OF POISONING

Time: 18 minutes
DISCUSSION PRESENTATION: TYPES OF POISONING
Poisons are generally placed in four categories based on how they enter the body. These categories are: ingestion, inhalation, absorption, and injection.
INGESTED POISONS
DISCUSSION PRESENTATION: INGESTED POISONS

Ingested poisons are those that are swallowed and include items such as foods, drugs, medications, and household items. Young children tend to put almost everything in their mouths, so they are at a higher risk of ingesting poisons. Seniors may make medication errors if they are prone to forgetfulness or have difficulty reading the small print on medicine container labels. Food can be another type of ingested poison.
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INGESTED POISONS Continued
Two of the most common categories of food poisoning are bacterial food poisoning and chemical food poisoning (also known as environmental food poisoning). Food poisoning by Salmonella, often found in poultry and raw eggs, is one of the most common types of bacterial food poisoning. The most deadly type of food poisoning is botulism, caused by a bacterial toxin associated with home canning.
SIGNALS OF INGESTED POISONS

DISCUSSION PRESENTATION: SIGNALS OF INGESTED POISONS
Signals of ingested poisons include: Nausea, vomiting or diarrhea. Chest or abdominal pain. Trouble breathing. Sweating. Changes in level of consciousness. Seizures. Headache or dizziness. Weakness. Irregular pupil size. Burning or tearing eyes. Abnormal skin color. Burn injuries around the lips or tongue or on the skin around the mouth. Signals of food poisoning, which can begin between 1 and 48 hours after eating contaminated food, include: Nausea. Vomiting. Abdominal pain. Diarrhea. Fever. Dehydration.
CARE FOR INGESTED POISONS

DISCUSSION PRESENTATION: CARE FOR INGESTED POISONS

For ingested poisons, immediately call the PCC and follow their instructions. DO NOT give the person anything to eat or drink unless you are told to do so. If you do not know what the poison was and the person vomits, save some of the vomit. In some cases of ingested poisoning, the Poison Control Center may instruct you to induce vomiting. Vomiting may prevent the poison from moving to the small intestine where most absorption takes place. However, do not induce vomiting unless advised by a medical professional. Vomiting should not be induced if the person: Is unconscious. Is having a seizure. Is pregnant (in the last trimester). Has ingested a corrosive substance (such as drain cleaner or oven cleaner) or a petroleum product (such as kerosene or gasoline). Is known to have heart disease. Some people who have contracted food poisoning may require antibiotic or antitoxin therapy. Fortunately, most cases of food poisoning can be prevented by proper food handling and preparation.
LESSON
31
205
DRAFT
INHALED POISONS
DISCUSSION PRESENTATION: INHALED POISONS

Poisoning by inhalation occurs when a person breathes in poisonous gases or fumes. Examples of inhaled poisons include carbon monoxide, carbon dioxide, chlorine gas, ammonia, sulphur dioxide, nitrous oxide, chloroform, dry cleaning solvents, fire extinguisher gases, industrial gases and hydrogen sulphide. Carbon monoxide, an odorless, colorless gas, is a commonly inhaled poison.
SIGNALS OF INHALED POISONS

DISCUSSION PRESENTATION: SIGNALS OF INHALED POISONS

Look for a substance around the mouth and nose of the person if you suspect deliberate inhalation. A pale or bluish skin color indicating a lack of oxygen may signal carbon monoxide poisoning. Other signals include: Trouble breathing or a breathing rate that is faster or slower than normal. Chest pain or tightness. Nausea and vomiting. Cyanosis. Headaches, dizziness, confusion. Coughing, possibly with excessive secretions. Seizures. Altered mental status with possible unresponsiveness.
CARE FOR INHALED POISONS

DISCUSSION PRESENTATION: CARE FOR INHALED POISONS
Follow appropriate safety precautions to ensure that you do not also become poisoned. Toxic fumes may or may not have an odor. If you notice clues at an emergency scene that lead you to suspect toxic fumes, such as a strong smell of fuel, or a hissing sound like gas escaping from a pipe or valve, you may not be able to reach the person without risking your own safety. If these clues are present, call 9-1-1 or the local emergency number instead of entering the scene. Anyone who has inhaled a poison needs oxygen as soon as possible. If you can remove the person from the source of the poison without endangering yourself, then do so. Help a conscious person by getting him or her to fresh air and then calling 9-1-1 or the local emergency number. If the person is unconscious, remove him or her from the scene if it is safe to do so and call 9-1-1 or the local emergency number. Then give care for any other life-threatening conditions.
ABSORBED POISONS
DISCUSSION PRESENTATION: ABSORBED POISONS

An absorbed poison enters the body through the skin or the mucous membranes in the eyes, nose, and mouth. Absorbed poisons come from plants, such as poison ivy, poison oak and poison sumac, as well as from dry and wet chemicals, such as fertilizers and pesticides used in lawn and plant care. Some medications, such as topical medications or transdermal patches, can also be absorbed through the skin.
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DRAFT
SIGNALS OF ABSORBED POISONS
DISCUSSION PRESENTATION: SIGNALS OF ABSORBED POISONS
Some of the signals of absorbed poisons include: Traces of the liquid, powder or chemical on the persons skin. Skin that looks burned, irritated, red or swollen. Blisters that may ooze fluid, or a rash. Itchy skin.
CARE FOR ABSORBED POISONS

DISCUSSION PRESENTATION: CARE FOR ABSORBED POISONS
To care for a person who has come into contact with a poisonous plant, follow standard precautions and then immediately rinse the affected area thoroughly with water. Before washing the affected area, you may need to have the person remove any jewelry, which is only necessary if the jewelry is contaminated or if it constricts circulation due to swelling. Rinse the affected area for at least 20 minutes. If a rash or weeping lesion develops, advise the person to seek the opinion of a pharmacist or health care provider about possible treatment. Antihistamines may help dry up lesions and help stop or reduce itching. Over-the-counter antihistamines are available and should be used according to the manufacturers directions. Have the person see a health care provider if the condition gets worse or involves areas of the face. If the poisoning involves dry chemicals, brush off the chemicals using a gloved hand before flushing with tap water (under pressure). Be careful not to inhale any of the chemical or get the chemical on you, your eyes, or the eyes of the person or any bystanders. If wet chemicals contact the skin, flush the area continuously with large amounts of cool running water. Continue flushing at least 20 minutes or until EMS personnel arrive. If a poison has been in contact with the persons eye or eyes, irrigate the affected eye or eyes, from the nose side of the eye, not directly onto the middle of the cornea of the eye, with clean water for at least 20 minutes. If only one eye is affected, do not let the water run into the unaffected eye by tilting the head so the water runs from the nose side of the eye downward to the ear side. Continue care as long as advised by the PCC or until EMS personnel take over.
INJECTED POISONS
DISCUSSION PRESENTATION: INJECTED POISONS
Injected poisons enter the body through the bites or stings of certain insects, spiders, aquatic life, animals and snakes, or as drugs or misused medications injected with a hypodermic needle. Insect and animal bites and stings are among the most common sources of injected poisons. Chapter 17 describes the general signals of stings and bites as well as the appropriate care. Chapter 18 provides information about injected poisonsthe use of injected drugs.
Instructors Note: Lesson 32 describes the general signals of stings and bites as well as the appropriate care.
LESSON
31
207
DRAFT
SIGNALS OF INJECTED POISONS
DISCUSSION PRESENTATION: SIGNALS OF INJECTED POISONS
Some of the signals of injected poisons include: Bite or sting mark at the point of entry. A stinger, tentacle or venom sac in or near the entry site. Redness, pain, tenderness or swelling around the entry site. Signs of allergic reaction, including localized itching, hives or rash. Signs of a severe allergic reaction (anaphylaxis), including weakness, nausea, dizziness, swelling of the throat or tongue, constricted airway or trouble breathing.
CARE FOR INJECTED POISONS

DISCUSSION PRESENTATION: CARE FOR INJECTED POISONS

When caring for an injected poison, check the person for life-threatening conditions and care for any found. If none are present, apply an ice pack or cold pack to reduce pain and swelling in the affected area. Call 9-1-1 or the local emergency number if the person has signals of anaphylaxis.
TOPIC:
ANAPHYLAXIS

Time: 7 minutes
DISCUSSION PRESENTATION: ANAPHYLAXIS
Anaphylaxis refers to a severe allergic reaction to poisons. Although rare, when it occurs, it truly is a life-threatening medical emergency. Anaphylaxis is a form of shock. It can be caused by insect bites or stings or contact with certain drugs, medications, foods and chemicals, resulting from any of the four modes of poisoning. Anaphylaxis usually occurs suddenly, within seconds or minutes after the person comes into contact with the poisonous substance. The skin or area of the body that came in contact with the substance usually swells and turns red. Other signals include: Trouble breathing, wheezing or shortness of breath. Tight feeling in the chest and throat. Swelling of the face, throat or tongue. Weakness, dizziness or confusion. Rash or hives. Low blood pressure. Shock. Trouble breathing can progress to an obstructed airway as the lips, tongue, throat and larynx swell. Low blood pressure and shock may accompany these reactions. Death usually occurs because the persons breathing is severely impaired.
CARE FOR ANAPHYLAXIS

DISCUSSION PRESENTATION: CARE FOR ANAPHYLAXIS
Call 9-1-1 or the local emergency number immediately if the person: Has trouble breathing. Complains of the throat tightening. Explains that he or she is subject to severe allergic reactions. Is or becomes unconscious.
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DRAFT
CARE FOR ANAPHYLAXIS Continued
If you suspect anaphylaxis, and have called for advanced medical help, follow these general guidelines for giving care: Monitor the persons airway and breathing for changes in his or her condition. Give care for life-threatening emergencies. Check a conscious person to determine: The substance (antigen) involved. The route of exposure to the antigen. The effects of the exposure. If the person is conscious and able to talk, ask: What is your name? What happened? How do you feel? Do you feel any tingling in your hands, feet or lips? Do you feel pain anywhere? Do you have any allergies? Do you have prescribed medications to take in case of an allergic reaction? Do you know what triggered the reaction? How much and how long were you exposed? Do you have any medical conditions or are you taking any medications? Quickly check the person from head to toe. Visually inspect the body: Observe for signals of anaphylaxis including respiratory distress. Look for a medical identification (ID) tag, bracelet or necklace. Check the persons head: look for swelling of the face, neck or tongue; notice if the person is drowsy, not alert, confused or exhibiting slurred speech. Check skin appearance. Look at persons face and lips. Ask yourself, is the skin cold or hot, unusually wet or dry, or pale, ashen, bluish, or flushed? Check the persons breathing. Ask if he or she is experiencing pain during breathing. Notice rate, depth of breaths, wheezing or gasping sounds. Care for respiratory distress. Help the person rest in the most comfortable position for breathing, which is usually sitting. Calm and reassure the person. Assist the person with using a prescribed epinephrine auto-injector, if available and permitted by state regulations. You may also need to assist with a second dose in a situation when signals of anaphylaxis persist after several minutes, or return, and EMS is delayed. Document any changes in the persons condition over time.
VIDEO PRESENTATION: ASSISTING WITH AN EPINEPHRINE AUTO-INJECTOR
Show the video segment, Assisting with an Epinephrine Auto-Injector (2.56 minutes). Instructors Note: An optional lesson for assisting with an epinephrine auto-injector can be found on Instructors Corner.
LESSON
31
209
DRAFT TOPIC:
POISONING PREVENTION
Time: 3 minutes
DISCUSSION PRESENTATION: POISONING PREVENTION
Follow these general guidelines to prevent most poisoning emergencies: Keep all medications and household products well out of the reach of children. Use special latches and clamps or other methods to keep children from opening cabinets or from reaching any substances that may be poisonous. Consider all household or drugstore products to be potentially harmful. Use childproof safety caps on containers of medication and other potentially dangerous products. Keep products in their original containers, with the labels in place. Use poison symbols to identify dangerous substances, and teach children what the symbols mean. Dispose of outdated medications and household products properly and in a timely manner. Use potentially dangerous chemicals only in well-ventilated areas. Wear proper clothing when work or recreation may put you in contact with a poisonous substance. Immediately wash those areas of the body that you suspect may have come into contact with a poison. Be aware of which common household items can be poisonous.
TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Poisoning can occur in any one of four ways: ingestion, inhalation, absorption and injection. The severity of a poisoning depends on the type and amount of the substance; the time elapsed since the poison entered the body; and the persons size, weight and age. For suspected poisonings, call the National Poison Control Center at 800-222-1222 and follow their directions. Call 9-1-1 or the local emergency number if the person has any life-threatening conditions. Also, look for any signals of anaphylaxis and assist the person with administering a prescribed auto-injector or antihistamine as needed. Answer participants questions. Read Chapter 17 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 32
SUDDEN ILLNESSES III/BITES AND STINGS

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify the signals of the most common types of bites and stings. Describe how to care for insect stings. Describe how to care for tick bites. Identify the signals and care of tick-borne illnesses. Identify the signals and care of West Nile virus. Describe how to care for spider bites and scorpion stings. Describe how to care for venomous snake bites. Describe how to care for marine life stings. Describe how to care for domestic and wild animal bites. Describe how to care for human bites. Identify ways to protect yourself from bites and stings.

To complete this lesson and meet the lesson objectives, you must: List the common signals associated with bites and stings. Review the care related to specic bites and stings, including, insect stings, tick bites, spider bites, scorpion stings, venomous snake bites, marine life stings, domestic and wild animal bites and human bites. Identify the various tick-borne illnesses. Discuss the signals associated with tick-borne illnesses and the related care. Describe West Nile Virus as being transmitted by mosquito bites, reviewing the signals for the illness and care required. Conduct the activity about ways to prevent bites from insects and ticks.

LCD projector, screen and computer Participants textbook Course Presentation: Part Five, Sudden Illnesses III/Bites and Stings Newsprint or chalkboard Markers or chalk
LESSON
32
Sudden Illnesses III/Bites and Stings
211
DRAFT TOPIC:
INTRODUCTION

Time: 3 minutes
Bites and stings are among the most common forms of injected poisonings. As a lay responder, you need to learn how to recognize, care for and prevent some of the most common types of bites and stingsthose of insects, ticks, spiders and scorpions, marine life, snakes, domestic and wild animals and humans.
TOPIC:
SIGNALS AND CARE FOR SPECIFIC BITES AND STINGS
Time: 30 minutes
INSECT STINGS
DISCUSSION PRESENTATION: INSECT STINGS

Between 0.5 to 5 percent of the American population is severely allergic to substances in the venom of bees, wasps, hornets and yellow jackets. For highly allergic people, even one sting can result in anaphylaxis. Signals of an insect sting include: Presence of a stinger. Pain. Swelling. Signals of an allergic reaction. When highly allergic people are stung, call 9-1-1 or the local emergency number immediately for medical care. For most people, insect stings may be painful or uncomfortable but are not life threatening. To give care for an insect sting: Remove any visible stinger, scraping it away from the skin with the edge of a plastic card, or use tweezers. In the case of a bee sting, if you use tweezers, grasp the stinger not the venom sac to prevent the sac from bursting and releasing more venom into the skin. Wash the site with soap and water. Cover the site to keep it clean. Apply an ice or cold pack to the area to reduce the pain and swelling. Ask the person if he or she has had any prior allergic reactions and observe for signals of an allergic reaction, even if there is no known history. If you observe any signals of anaphylaxis, call 9-1-1 or the local emergency number immediately.
TICK BITES
DISCUSSION PRESENTATION: TICK BITES

Tick bites can contract, carry and transmit disease to humans. Some of the diseases spread by ticks including Rocky Mountain Spotted Fever, Babesia infection, ehrlichiosis, and Lyme disease. If you find an embedded tick: With a gloved hand, grasp the tick with fine-tipped, non-etched, non-rasped tweezers as close to the skin as possible and pull slowly, steadily, and firmly upward. If you do not have tweezers, use a glove, plastic wrap, a piece of paper or a leaf to protect your fingers.
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DRAFT
TICK BITES Continued
Do not try to burn the tick off. Do not apply petroleum jelly or nail polish to the tick. Place the tick in a jar containing rubbing alcohol to kill it. Wash the site with soap and water. Apply antiseptic or triple antibiotic ointment to help prevent infection. Wash your hands thoroughly. If rash, flu-like signals or joint pain appears, seek medical attention. If you cannot remove the tick, have the person seek medical care. Even if you can remove the tick, a person may want to let his or her health care provider know that he or she has been bitten by a tick in case he or she becomes ill within the following month or two. Check the site periodically thereafter. If rash or flu-like signals develop, seek medical care. Redness at the site of a tick bite does not necessarily mean a person is infected with a disease.
ROCKY MOUNTAIN SPOTTED FEVER

DISCUSSION PRESENTATION: ROCKY MOUNTAIN SPOTTED FEVER
Rocky Mountain spotted fever is caused by the transmission of microscopic bacteria from the wood tick or dog tick host to other warm-blooded animals, including humans. Initial signals of Rocky Mountain spotted fever usually appear between 2 and 14 days after a tick bite and include: Fever. Nausea and vomiting. Muscle aches or pain. Lack of appetite. Severe headache. Later signals include: Spotted rash, usually starting a few days after fever develops, first appearing as small spots on the wrists and ankles, and then spreading to the rest of the body. Abdominal pain. Joint pain. Diarrhea. Call a health care provider if the person develops signals; the health care provider is likely to prescribe antibiotics. If left untreated, complications can be life threatening.
BABESIA INFECTION
DISCUSSION PRESENTATION: BABESIA INFECTION

Babesia, also called Babesiosis is a protozoa infection spread by deer ticks and black-legged ticks. Many people infected with Babesia have no apparent symptoms. Some people may have flu-like symptoms, such as: Fever. Sweats. Chills. Body aches and headaches. No appetite. Nausea. Fatigue. Others infected with Babesia develop a type of anemia that can cause jaundice and dark urine.
LESSON
32
213
DRAFT
BABESIA INFECTION Continued
In some people, such as the elderly or persons without a spleen, or those with a weak immune system or serious health condition, Babesia can be life threatening if untreated. If a person develops any of the signals, he or she should seek medical care. Most people with signals of the disease can be treated successfully with prescription medications.
EHRLICHIOSIS
DISCUSSION PRESENTATION: EHRLICHIOSIS

Most cases of infection with the bacteria ehrlichia in humans are caused by bites by an infected Lone Star tick. Many people with ehrlichiosis do not become ill. Some develop only mild signals that are seen 5 to 10 days after an infected tick bit the person. Initial signals include: Fever. Headache. Fatigue. Muscle aches. Other signals that may develop include: Nausea or vomiting. Diarrhea. Cough. Joint pains. Confusion. Rash (in some cases). If the person becomes ill with any of the above signals, he or she should seek medical care. Ehrlichiosis is treated with antibiotics.
LYME DISEASE
DISCUSSION PRESENTATION: LYM E DISEASE
Lyme disease, or Lyme borreliosis, is another illness that people can get from the bite of an infected tick. Lyme disease is spread by the deer tick and black-legged tick, which attach themselves to mice and deer. The tick attaches itself to any warm-blooded animal, including humans. Most cases of infection occur between May and late August when ticks are most active and people spend more time outdoors. The tick must remain embedded in human skin for about 36 to 48 hours to transmit the disease. Signals of Lyme disease include: A rash, appearing a few days or a few weeks after a tick bite, starting as a small red area at the site of the bite, possibly spreading up to 7 inches across, In fair-skinned people, the center of the rash is lighter in color and the outer edges are raised and red, sometimes giving the rash a bulls-eye appearance. In dark-skinned people, the rash area may look black and blue, like a bruise. The rash may or may not be warm to the touch and usually is not itchy or painful. Some people with Lyme disease never develop a rash. Fever. Headache. Weakness. Joint and muscle pain.
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LYME DISEASE Continued
Signals are similar to those of the flu and can develop slowly and not occur at the same time as a rash. Lyme disease can get worse if not treated, affecting the brain and nervous system and the heart. If rash or flu-like signals develop, the person should seek medical care immediately; antibiotics are highly effective against Lyme disease. If you suspect Lyme disease, do not delay seeking treatment. Treatment time is longer and less effective when the person has been infected for a long period of time.
MOSQUITO-BITES: WEST NILE VIRUS

DISCUSSION PRESENTATION: MOSQUITOBITES: WEST NILE VIRUS

West Nile virus (WNV) is passed on to humans and other animals by mosquitoes that bite them after feeding on infected birds. It cannot be passed from one person to another. Most people with WNV have no signals. Signals, typically develop between 3 and 14 days after the bite of an infected mosquito and include: High fever. Headache. Neck stiffness. Confusion. Coma. Tremors. Convulsions. Muscle weakness. Vision loss. Numbness. Paralysis. These signals may last several weeks; in some cases, WNV can cause fatal encephalitis, which is swelling of the brain that leads to death. If you suspect a person may have signals of severe WNV illness, such as unusually severe headaches or confusion, seek medical attention immediately. There is no specific treatment for WNV infection or a vaccine to prevent it.
SPIDER BITES AND SCORPION STINGS

DISCUSSION PRESENTATION: SPIDER BITES AND SCORPION STINGS

Few spiders in the United States have venom that causes death. However, the bites of black widow and brown recluse spiders can cause serious illness and are occasionally fatal. Another dangerous spider is the northwestern brown or hobo spider. The black widow spider is black with a reddish hourglass-shaped marking on its underbody. The brown recluse spider is light brown with a darker brown, violin-shaped marking on the top of its body. Both of these spiders prefer dark, out-of-the-way places where they are seldom disturbed. Bites usually occur on the hands or arms of people reaching into places, such as wood, rock and brush piles, or rummaging in dark garages and attics. Scorpions are found in dry regions of the southwestern United States and Mexico and live in cool, damp places, such as basements, junk piles, woodpiles, and under the bark of living or fallen trees. They are most active in the evening and at night, which is when most stings occur. Because it is difficult to distinguish highly poisonous scorpions from the nonpoisonous scorpions, all scorpion stings should be treated as medical emergencies.
LESSON
32
215
DRAFT
SIGNALS OF SPIDER BITES AND SCORPION STINGS
DISCUSSION PRESENTATION: SIGNALS OF SPIDER BITES AND SCORPION STINGS
The bite of the black widow spider, the most painful and deadly (especially on very young children and the elderly), usually causes an immediate sharp pinprick pain, followed by a dull pain in the area of the bite. Other signals of a black widow spider bite include: Rigid muscles in the shoulders, chest, back and abdomen. Restlessness. Anxiety. Dizziness. Headache. Excessive sweating. Weakness. Drooping or swelling of the eyelids. The bite of the brown recluse spider may produce little or no pain initially. Pain in the area of the bite develops an hour or more later. A blood-filled blister forms under the surface of the skin, sometimes in a target or bulls-eye pattern. Over time, the blister increases in size and eventually ruptures, leading to tissue destruction and a black scab. The hobo spider also can produce an open, slow-healing wound. General signals of spider bites and scorpion stings may include: A mark indicating a possible bite or sting. Severe pain in the sting or bite area. A blister, lesion or swelling at the entry site. Nausea and vomiting. Stiff or painful joints. Chills or fever. Trouble breathing or swallowing or signs of anaphylaxis. Sweating or salivating profusely. Muscle aches or severe abdominal or back pain. Dizziness or fainting. Chest pain. Elevated heart rate. Infection at the site of the bite.
CARE FOR SPIDER BITES AND SCORPION STINGS

DISCUSSION PRESENTATION: CARE FOR SPIDER BITES AND SCORPION STINGS
Call 9-1-1 or the local emergency number immediately if you suspect that someone has been bitten by a black widow spider or brown recluse spider; stung by a scorpion; or the person has any other life-threatening conditions. While waiting for help to arrive: Wash the site with soap and water Bandage the wound. Apply an antibiotic ointment to the bandage first if the person has no known allergies or sensitivities to the medication. Apply an ice or a cold pack to the site to reduce pain and swelling. If 9-1-1 or the local emergency number has not been called, encourage the person to seek medical attention. If you transport the person to a medical facility, keep the bitten area elevated and as still as possible.
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DRAFT
VENOMOUS SNAKEBITES
DISCUSSION PRESENTATION: VENOMOUS SNAKEBITES
Snakebites kill few people in the United States; most deaths occur because the person has an allergic reaction, is in poor health or because too much time passes before the person receives medical care. Rattlesnakes account for most snakebites and nearly all deaths due to snakebites. Signals that indicate a venomous snakebite include: One or two distinct puncture wounds, which may or may not bleed. The exception is the coral snake, whose teeth leave a semicircular mark. Severe pain and burning at the wound site immediately after or within 4 hours of the incident. Swelling and discoloration at the wound site immediately after or within 4 hours of the incident. If the bite is from a venomous snake, such as a rattlesnake, copperhead, cottonmouth or coral snake, call 9-1-1 or the local emergency number immediately. Give care until help arrives: Wash the site with soap and water. Apply an elastic (pressure immobilization) bandage to slow the spread of venom through the lymphatic system by following these steps: Check for feeling, warmth and color of the limb and note changes in skin color and temperature. Place the end of the bandage against the skin and use overlapping turns. The wrap should cover a long body section, such as an arm or a calf, beginning at the point farthest from the heart. For a joint, such as the knee or ankle, use figure-eight turns to support the joint. Check above and below the injury for feeling, warmth and color, especially fingers and toes, after you have applied an elastic roller bandage. Check the snugness of the bandaginga finger should easily, but not loosely, pass under the bandage. Keep the injured area still and lower than the heart. The person should walk only if absolutely necessary. For any snakebite: do not apply ice, cut the wound, apply suction, apply a tourniquet, or use electric shock, such as from a car battery.
MARINE LIFE STINGS

DISCUSSION PRESENTATION: MARINE LIFE STINGS

The stings of some forms of marine life are not only painful but can also make you sick and, in some parts of the world, can kill you. The side effects include allergic reactions that can cause breathing and heart problems, as well as paralysis and death. Signals of marine life stings include: Possible puncture marks. Pain. Swelling. Signs of a possible allergic reaction. Call 9-1-1 or the local emergency number if the person does not know what stung him or her, has a history of allergic reactions to marine-life stings, is stung on the face or neck, or starts to have trouble breathing. Take these additional steps if you encounter someone who has a marine-life sting: Get a lifeguard to remove the person from the water as soon as possible. If a lifeguard is not available, use a reaching assist, if possible. Avoid touching the person with your bare hands, which could expose you to the stinging tentacles. Use gloves or a towel when removing any tentacles.
LESSON
32
217
DRAFT
MARINE LIFE STINGS Continued
If you know the sting is from a jellyfish, irrigate the injured part with large amounts of vinegar as soon as possible for at least 30 seconds to help remove the tentacles and stop the injection of venom. Vinegar works best to offset the toxin, but a baking soda slurry also may be used if vinegar is not available. If the sting is known to be from a bluebottle jellyfish, also known as a Portugese man-of-war, use ocean water instead of vinegar. Vinegar triggers further envenomation. Do not rub the wound, apply a pressure immobilization bandage or apply fresh water, aluminum sulfate, meat tenderizer or other remedies because this may increase pain. Once the stinging action is stopped and tentacles have been removed, care for pain by hot-water immersion. Have the person take a hot shower if possible for at least 20 minutes. The water temperature should be as hot as can be tolerated (non-scalding) or about 113 F if the temperature can be measured. If you know the sting is from a stingray, sea urchin or spiny fish: Flush the wound with tap water. Ocean water also may be used. Keep the injured part still and soak the affected area in non-scalding hot water (as hot as the person can stand) for at least 20 minutes or until the pain goes away. If hot water is not available, packing the area in hot sand may have a similar effect if the sand is hot enough. Carefully clean the wound and apply a bandage. Watch for signals of infection and check with a health care provider to determine if a tetanus shot is needed.
DOMESTIC AND WILD ANIMAL BITES

DISCUSSION PRESENTATION: DOM ESTIC AND WILD ANIMAL BITES

The bite of a domestic or wild animal carries the risk of infection, as well as soft tissue injury. Dog bites are the most common of all bites from domestic or wild animals. One of the most serious possible infections is rabies, a disease caused by a virus transmitted commonly through the saliva of diseased mammals. If not treated, rabies is fatal. Anyone bitten by a wild or domestic animal must get professional medical attention as soon as possible. A series of vaccine injections are given to the person to build up immunity to prevent rabies from occurring. Tetanus is another potentially fatal infection that can occur in wounds created by animal or human bites. Signals of tetanus include irritability, headache, fever and painful muscular spasms (stiffness in the jaw). Signals of a bite include a bite mark and bleeding. If a person is bitten, try to get him or her away from the animal without endangering yourself; do not try to capture or restrain the animal. Call 9-1-1 or the local emergency number if the wound is bleeding seriously or you suspect the animal might have rabies. If possible, try to remember the animals appearance and where you last saw it. To care for an animal bite: Control bleeding first if the wound is bleeding seriously. Do not clean serious wounds. The wound will be cleaned at a medical facility. If bleeding is minor: Wash the wound with soap and water and then irrigate with large amounts of clean running tap water to minimize the risk of infection. Control any bleeding.
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DOMESTIC AND WILD ANIMAL BITES Continued
Cover the wound with a dressing. Apply an antibiotic ointment to thedressing first if the person has no known allergies or sensitivities to the medication. Watch for signals of infection. Advise the person to see additional care from their health care provider or a medical facility.
HUMAN BITES
DISCUSSION PRESENTATION: HUMAN BITES
Human bites are quite common and differ from other bites because they may be more contaminated, tend to occur in higher-risk areas of the body and often receive delayed care. Human saliva has been found to contain at least 42 different kinds of species of bacteria, and serious infection often follows a human bite. According to the Centers for Disease Control and Prevention (CDC), human bites are not considered to carry a risk of transmitting the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). Children are often the inflictors and the recipients of human bite wounds. As with animal bites, it is important to get the person with a human bite to professional medical care as soon as possible so that antibiotic therapy can be prescribed, if necessary. If the bite is severe, call 9-1-1 or the local emergency number, and control bleeding first if the wound is bleeding severely. Do not clean serious wounds; they will be properly cleaned at a medical facility. If bleeding is minor: Wash it with soap and water, and then irrigate with large amounts of clean running tap water to minimize the risk of infection. Control any bleeding. Cover the wound with a dressing. Apply an antibiotic ointment to the dressing first if the person has no known allergies or sensitivities to the medication. Watch for signals of infection. Advise the person to seek additional care from their health care provider or medical facility.
TOPIC:
PREVENTING BITES AND STINGS

Time: 10 minutes
ACTIVITY
Tell participants that preventing bites and stings is the best protection against the transmission of injected poisons. Divide the class into three small groups and assign each group one of the following topics: Wooded or grassy areas; marine animal stings; and dog bites. Have each group use the textbook and develop a list of actions to take to prevent bites and stings. Then, have each group share their information with the rest of the class.
Instructors Note: Participants responses should include the following: For wooded or grassy areas: Wear long-sleeved shirts and long pants. Tuck your pant legs into your socks or boots. Use a rubber band or tape to hold pants against socks so that nothing can get under clothing. Tuck your shirt into your pants.
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PREVENTING BITES AND STINGS Continued
Wear light-colored clothing to make it easier to see tiny insects or ticks. When hiking in woods and elds, stay in the middle of trails. Avoid underbrush and tall grass. If you are outdoors for a long time, check yourself several times during the day. Especially check in hairy areas of the body like the back of the neck and the scalp line. Inspect yourself carefully for insects or ticks after being outdoors or have someone else do it. Consider staying indoors at dusk and dawn, when mosquitoes are most active. If you must be outside, follow the clothing suggestions above. Get rid of mosquito breeding sites by emptying sources of standing water outside of the home, such as from owerpots, buckets and barrels. Also, change the water in pet dishes, replace the water in bird baths weekly, drill drainage holes in tire swings so that water drains and keep childrens wading pools empty and on their sides when they are not being used. Avoid walking in areas where snakes are known to live. If you encounter a snake, look around for others. Turn around and walk away on the same path on which you came. Wear sturdy hiking boots. If you have pets that go outdoors, spray them with repellent made for that type of pet. Apply the repellent according to the label and check your pet for ticks often. If you will be in a grassy or wooded area for a long time or if you know that an area is highly infested with insects, ticks or mosquitoes, consider using a repellent. Follow the label instructions carefully. For marine animal stings: consider wearing a wet suit or dry suit or protective footwear in the water, especially during high-risk times or areas. For dog bites: Do not run past a dog. The dogs natural instinct is to chase and catch prey. If a dog threatens you, do not scream. Avoid eye contact, try to remain motionless until the dog leaves, and then back away slowly until the dog is out of sight. Do not approach a strange dog, especially one that is tied or conned. Always let a dog see and sniff you before you pet the animal.
TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Bites and stings are one of the most common types of injected poisonings Call the local or national poison control center or local emergency number. The best way to avoid any kind of poisoning is to take steps to prevent it. Answer participants questions. Read Chapter 18 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 33
SUDDEN ILLNESSES IV/SUBSTANCE ABUSE AND MISUSE

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify the main categories of commonly abused or misused substances. Identify the signals that may indicate substance abuse or misuse. Describe how to care for someone who you suspect or know is abusing or misusing a substance. Explain how you can help prevent substance abuse and misuse.

To complete this lesson and meet the lesson objectives, you must: Briey review the most commonly used and abused substances. Conduct the activity related to dening the forms of substance abuse and misuse. List the common signals associated with substance abuse and misuse. Review the care of a person with substance abuse and misuse. Engage participants in a discussion about ways to prevent substance abuse and misuse.

LCD projector, screen and computer Participants textbook Course Presentation: Part Five, Sudden Illnesses IV/Substance Abuse and Misuse Newsprint or chalkboard Markers or chalk
TOPIC:
INTRODUCTION
Instructors Note:
Time: 10 minutes
You may want to invite a local drug enforcement agency (DEA) representative, a police department representative or a community group representative to enhance the discussions and identify drug problems in the participants community.

Substance abuse is the deliberate, persistent and excessive use of a substance without regard to health concerns or accepted medical practices. Substance misuse is the use of a substance for unintended purposes or for appropriate purposes but in improper amounts or doses. Substance misuse and abuse cost the United States billions of dollars each year in medical care, insurance and lost productivity. There is a tendency to think of illegal drugs when we hear of substance misuse or abuse. However, legal substances, including nicotine, alcohol, and over-the-counter medications, such as aspirin, sleeping pills and diet pills, are among those most often misused or abused.
LESSON
33
Sudden Illnesses IV/Substance Abuse and Misuse
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ACTIVITY
Ask participants to define the following: Drug Medication Dependency Addiction Tolerance Overdose Withdrawal Synergistic Effect
Instructors Note: Write participants responses on newsprint or a chalkboard and then compare their responses with the information provided in Chapter 18 in the textbook.
TOPIC:
ABUSED AND MISUSED SUBSTANCES

Time: 15 minutes
DISCUSSION PRESENTATION: ABUSED AND M ISUSED SUBSTANCES
Substances are categorized according to their effects on the body. The six major categories of commonly misused and abused substances are: Stimulants. Hallucinogens Depressants. Narcotics. Inhalants. Cannabis products. The category to which a substance belongs depends mostly on the way the substance is taken or the effects it has on the central nervous system. A heightened or exaggerated effect may be produced when two or more substances are used at the same time; this is called a synergistic effect.
STIMULANTS
DISCUSSION PRESENTATION: STIM ULANTS

Stimulants are drugs that affect the central nervous system by increasing physical and mental activity. The effects of stimulants include: Temporary feelings of alertness. Prevention of fatigue. Appetite suppression or enhanced exercise routines for weight reduction. Many stimulants are ingested as pills, but some can be absorbed or inhaled. Amphetamines, dextroamphetamines and methamphetamines are stimulants. Their slang names include uppers, bennies, black beauties, speed, crystal, meth and crank. Speed is a street term that usually refers to amphetamine or methamphetamine. One extremely addictive, dangerous and smokeable form of methamphetamine is called ice or crystal meth.
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STIMULANTS Continued

Cocaine is one of the most publicized and powerful stimulants. It can be taken in different ways, the most common of which is snorting or sniffing it in powder form. A purer form of cocaine is known as crack. Crack is smoked and the vapor is inhaled. Crack is highly addictive. Slang names for crack include rock and freebase rocks. The most common stimulants in America are legal. Leading the list is caffeine. The next most common stimulant is nicotine. Other stimulants used for medical purposes, such as asthma medications and decongestants, can be either taken by mouth or inhaled.
HALLUCINOGENS
DISCUSSION
PRESENTATION: HALLUCINOGENS
Hallucinogens, also known as psychedelics, are substances that affect mood, sensation, thought, emotion and self-awareness. They alter ones perception of time and space and produce visual, auditory and tactile delusions. Among the most widely abused hallucinogens are: Lysergic acid diethylamide (LSD), also known as acid. Psilocybin (mushrooms). Phencyclidine (PCP), which is called angel dust. Mescaline (peyote, buttons or mesc). These substances are usually ingested, but PCP also can be inhaled. Hallucinogens sometimes cause what is called a bad trip. A bad trip can involve intense fear, panic, paranoid delusions, vivid hallucinations, profound depression, tension and anxiety. The person may be irrational and feel threatened by any attempt others make to help.
DEPRESSANTS
DISCUSSION PRESENTATION: DEPRESSANTS

Depressants are substances that affect the central nervous system by slowing down physical and mental activity. Depressants are commonly used for medical purposes. Depressants can: Relieve anxiety. Promote sleep. Depress respiration. Relieve pain. Relax muscles. Impair coordination and judgment. Like other substances, the larger the dose or the stronger the substance, the greater its effects. Common depressants include barbiturates, benzodiazepines, narcotics and alcohol. Most depressants are ingested or injected. Depressants known as club drugs have gained popularity; these include ketamine, Rohypnol, and gamma-hydroxybutyrate (GHB). These drugs are particularly dangerous because they are often used in combination or with other depressants, which can have deadly effects. Alcohol is the most widely used and abused substance in the United States.
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DEPRESSANTS Continued

Alcohol in higher doses can have toxic effects. Drinking alcohol in large or frequent amounts can have many unhealthy consequences. Alcohol poisoning can occur when a large amount of alcohol is consumed in a short period of time. Alcohol poisoning can result in unconsciousness and, if untreated, death. Chronic drinking can: Affect the brain, causing a lack of coordination, memory loss and apathy. Cause liver disease, such as cirrhosis. Lead to psychological, family, social and work problems.
NARCOTICS
DISCUSSION PRESENTATION: NARCOTICS

Narcotics, derived from opium, are drugs that work on the central nervous system to relieve pain. Narcotics are so powerful and highly addictive that all are illegal without a prescription, and some are not prescribed at all. When taken in large doses, narcotics can produce euphoria, stupor, coma or death. The most common natural narcotics are morphine and codeine. Most other narcotics, including heroin, are synthetic or semi-synthetic. Oxycodone is a powerful semi-synthetic narcotic that has recently gained popularity as a street drug.
INHALANTS
DISCUSSION PRESENTATION: INHALANTS

Inhalants produce a mood-altering effect. They also depress the central nervous system. Inhalant use can damage the heart, lungs, brain and liver. Inhalants include medical anesthetics, such as amyl nitrite and nitrous oxide (also known as laughing gas), as well as hydrocarbons, known as solvents. Solvents effects are similar to those of alcohol. People who use solvents may appear to be drunk. Other effects include swollen mucous membranes in the nose and mouth, hallucinations, erratic blood pressure and seizures. Solvents include: Toluene, found in glues. Butane, found in lighter fluids. Acetone, found in nail polish removers. Fuels, such as gasoline and kerosene. Propellants, found in aerosol sprays.
CANNABIS PRODUCTS
DISCUSSION PRESENTATION: CANNABIS PRODUCTS

Cannabis products, including marijuana, tetrahydrocannabinol (or THC) and hashish, are all derived from the plant Cannabis sativa. Marijuana is the most widely used illicit drug in the United States. It is typically smoked in cigarette form or in a pipe, but it can also be ingested. The effects of marijuana include: Feelings of elation. Distorted perceptions of time and space. Impaired judgment and motor coordination. Throat irritation.
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CANNABIS PRODUCTS Continued
Red eyes. Rapid pulse. Dizziness. Increased appetite. Marijuana has been legalized in some states for limited medical use to help alleviate symptoms of certain conditions, such as multiple sclerosis. Legal synthetic versions are use to treat: Nausea from cancer chemotherapy. Glaucoma. Muscular weakness caused by multiple sclerosis. Weight loss from cancer and AIDS.
DESIGNER DRUGS
DISCUSSION PRESENTATION: DESIGNER DRUGS

Designer drugs are variations of other substances, such as narcotics and amphetamines. The molecular structures of designer drugs include substances used for medical purposes that are modified by chemists. These modifieddesignedsubstances become extremely potent and dangerous street drugs. When the chemical makeup of a drug is altered, the user can experience a variety of unpredictable and dangerous effects. One of the more commonly used designer drugs is methylenedioxymethamphetamine (MDMA), also known as ecstasy. Ecstasy is popular because it evokes a euphoric high. Other signals of ecstasy use include: Increased blood pressure. Rapid heartbeat. Profuse sweating. Paranoia. Sensory distortion. Erratic mood swings.
ANABOLIC STEROIDS
DISCUSSION PRESENTATION: ANABOLIC STEROIDS

Anabolic steroids are drugs that are sometimes used by athletes to enhance performance and increase muscle mass. Their medical uses include stimulating weight gain for persons unable to gain weight naturally. Chronic use of anabolic steroids can lead to sterility, liver cancer and personality changes. Steroid abuse by young people may also disrupt normal growth.
OVER-THE-COUNTER SUBSTANCES
DISCUSSION PRESENTATION: OVER-THECOUNTER SUBSTANCES

The most commonly misused and abused over-the-counter substances include aspirin, nasal sprays, laxatives and emetics. Aspirin is used to relieve minor pain, reduce fever and treat heart disease. Misusing aspirin can cause inflammation of the stomach and small intestine, which can result in bleeding ulcers. Aspirin can also impair normal blood clotting. Decongestant nasal sprays can help relieve the congestion of colds or hay fever. If misused, they can cause physical dependency. Using the spray over a long period can cause nosebleeds and changes in the lining of the nasal passages, eventually making it difficult to breathe without the spray.
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33
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OVER-THE-COUNTER SUBSTANCES Continued

Laxatives are used to relieve constipation, but when used improperly, they can cause uncontrolled diarrhea that may result in dehydration. Emetics are drugs that induce vomiting. A popular over-the-counter emetic is ipecac syrup, which had been previously recommended for ingested poisoning. However, improper use can be dangerous and cause recurrent vomiting, diarrhea, dehydration, pain and weakness in the muscles, abdominal pain and heart problems. Laxative and emetic abuse is associated with attempted weight loss and eating disorders, such as anorexia nervosa and bulimia. Anorexia nervosa, a disorder that typically affects young women, is characterized by a long-term refusal to eat food with sufficient nutrients and calories. Anorexics typically use laxatives and emetics to keep from gaining weight. Bulimia is a condition in which persons gorge themselves with food and then purge by vomiting or using laxatives. Both of these eating disorders have underlying psychological factors that contribute to their onset. The effect of both of these eating disorders is severe malnutrition, which can result in death.
TOPIC:
SIGNALS OF SUBSTANCE ABUSE AND MISUSE

Time: 5 minutes
DISCUSSION PRESENTATION: SIGNALS OF SUBSTANCE ABUSE AND M ISUSE
Many of the signals of substance misuse and abuse are similar to those of other medical emergencies. Do not necessarily assume that someone who is stumbling is disoriented or is intoxicated by alcohol or other drugs if he or she has a fruity, alcohol-like odor on the breath. Instead, the person may be having a diabetic emergency. Signals of possible substance misuse or abuse include: Behavioral changes not otherwise explained. Sudden mood changes. Restlessness, talkativeness or irritability. Changes in consciousness, including loss of consciousness. Slurred speech or poor coordination. Moist or flushed skin. Chills, nausea or vomiting. Dizziness or confusion. Abnormal breathing. Respiratory distress, disruption of normal heart rhythm and even death can result from a stimulant overdose. The person may appear very excited, restless, talkative or irritable, or the person may suddenly lose consciousness. Specific signals of hallucinogen abuse as well as some designer drugs may include sudden mood changes and a flushed face. The person may claim to see or hear something that is not present and may be anxious or frightened. Specific signals of depressant abuse include drowsiness, confusion, slurred speech, slow heart and breathing rates and poor coordination. A person who has consumed a great deal of alcohol in a short period of time may be unconscious or hard to arouse. The person may vomit violently. A person suffering from alcohol withdrawal, a potentially dangerous condition, may be confused or restless. The person may be trembling, experiencing hallucinations or having seizures.
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SIGNALS OF SUBSTANCE ABUSE AND MISUSE Continued

A telltale sign of cannabis use is red bloodshot eyes. A person abusing inhalants may appear drunk or disoriented.
TOPIC:
CARE FOR SUBSTANCE ABUSE AND MISUSE

Time: 5 minutes
DISCUSSION PRESENTATION: CARE FOR SUBSTANCE ABUSE AND M ISUSE
As in other medical emergencies, you do not have to diagnose substance misuse or abuse to give care. Follow these general principles as you would for any poisoning, normally an ingested poison: Check the scene to make sure it is safe to help the person. Do not approach the person if he or she is behaving in a threatening manner. Call 9-1-1 or the local emergency number if the person: Is unconscious, confused or seems to be losing consciousness. Has trouble breathing or is breathing irregularly. Has persistent chest pain or pressure. Has pain or pressure in the abdomen that does not go away. Is vomiting blood or passing blood. Has a seizure, a severe headache or slurred speech. Acts violently. If none of the above are present and you have good reason to suspect a substance was taken, call the Poison Control Center hotline at 800-122-2222 and follow their directions. Try to learn from the person or others what substance may have been taken. Calm and reassure the person. Keep the person from getting chilled or overheated. Check for any life-threatening conditions and give care as you would for any person with a sudden illness or injury. If possible interview the person or bystanders to find out what substance was taken, how much and when it was taken. Look for clues at the scene that suggest the nature of the problem, such as containers, pill bottles, drug paraphernalia and signals of other medical conditions. If you suspect someone has used a designer drug, tell EMS personnel. This is important because a person who has overdosed on a designer drug may not respond to usual medical treatment.
TOPIC:
PREVENTING SUBSTANCE ABUSE AND MISUSE

Time: 5 minutes
DISCUSSION PRESENTATION: PREVENTING SUBSTANCE ABUSE AND M ISUSE
Some poisonings from medicines occur when the persons knowingly increase the dosage beyond what is directed. The best way to prevent such misuse is to take medications only as prescribed. Many poisonings from medical substances are not intentional. Use these guidelines to help prevent unintentional misuse or overdose: Read the product information and use products only as directed.
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33
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DRAFT
PREVENTING SUBSTANCE ABUSE AND MISUSE Continued
Ask your health care provider or pharmacist about the intended use and side effects of prescriptions and over-the-counter medications. If you are taking more than one medication, check for possible interaction effects. Never use another persons prescribed medications. Always keep medications in their appropriate, marked containers. Destroy all out-of-date medications. Always keep medications out of the reach of children. Experts in the field of substance abuse generally agree that prevention efforts are far more cost effective than treatment. Preventing substance abuse is a complex process that involves many underlying factors including: A lack of parental supervision. The breakdown of traditional family structures. A wish to escape unpleasant surroundings and stressful situations. The widespread availability of substances. Peer pressure and the basic need to belong. Low self-esteem, including feelings of guilt and shame. Media glamorization, especially of alcohol and tobacco, promoting the idea that using substances enhances fun and popularity. A history of substance abuse in the home or community environment. Various prevention efforts, including educating people about substances and their effects on health and attempting to instill fear of penalties, have not by themselves proved particularly effective. To be effective, prevention efforts must address the various underlying factors of and approaches to substance abuse.
TOPIC:
CLOSING
Time: 5 minutes
DISCUSSION
There are six major categories of substances that, when abused or misused, can produce a variety of signals, some of which are indistinguishable from those of other medical emergencies. You do not have to diagnose the condition to give care. If you suspect that the persons condition is caused by substance misuse or abuse, give care for a poisoning emergency. Call 9-1-1 or the local emergency number or Poison Control Center personnel and follow their directions. If the person becomes violent or threatening, go to a safe place, call 9-1-1 or the local emergency number and do not return to the scene until EMS personnel and police arrive. Answer participants questions. Read Chapter 19 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 34
HEAT-RELATED ILLNESSES AND COLD-RELATED EMERGENCIES

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe how body temperature is controlled. Identify the factors that inuence how well the body maintains its temperature. Identify the risk factors that increase a persons susceptibility to heat-related illnesses and cold-related emergencies. List the signals of dehydration, heat cramps, heat exhaustion and heat stroke. Describe the care for dehydration, heat cramps, heat exhaustion and heat stroke. List the signals of frostbite and hypothermia. Describe the care for frostbite and hypothermia. Describe the ways to help prevent heat-related illnesses and cold-related emergencies.

To complete this lesson and meet the lesson objectives, you must: Briey explain how body temperature is controlled. Identify the factors that affect how the body regulates temperature, including those that place a person at increased risk for heat-related illnesses and cold-related emergencies. Conduct the activity related to becoming overcome by the heat. Describe dehydration. Discuss the three heat-related illnesses of heat cramps, heat exhaustion and heat stroke, including signals and related care. Describe the two types of cold-related emergencies: frostbite and hypothermia. Conduct the activity related to being overcome by cold. Discuss the signals and care for the two types of cold-related emergencies. Conduct the activity on prevention using the scenario.

LCD projector, screen and computer Participants textbook Course Presentation: Part Five, Heat-Related Illnesses and Cold-Related Emergencies Newsprint or chalkboard Markers or chalk Written handouts of scenario (optional)
LESSON
34
Heat-Related Illnesses and Cold-Related Emergencies
229
DRAFT TOPIC:
INTRODUCTION
Time: 3 minutes
The human body is equipped to withstand extremes in body temperature. However, when the body is overwhelmed in its attempt to regulate body temperature, a heat-related illness or cold-related emergency can occur. A heat-related illness or cold-related emergency can happen anywhereindoors or outdoors and under a variety of conditions. The signals of either are progressive and can quickly become life threatening. A person can develop a heat-related illness or cold-related emergency even when temperatures are not extreme. The effects of humidity, wind, clothing, living and working environments, physical activity, age and health all play a role in determining an individuals susceptibility.
TOPIC:
HOW BODY TEMPERATURE IS CONTROLLED

Time: 15 minutes
DISCUSSION PRESENTATION: HOW BODY TEM PERATURE IS CONTROLLED
To work efficiently, the human body must maintain a constant core temperature. Normal body temperature is approximately 98.6o F (37o C). The control center of body temperature is the hypothalamus, located in the brain. It receives information and adjusts body temperature accordingly, keeping the body within a specific range of temperature for cells to stay alive and healthy. The body produces heat through metabolism or the conversion of food and drink into energy. The body also gains heat with any kind of physical exercise. When the body starts to become too cold, blood vessels near the skin constrict (narrow) so it can keep the warmer blood near the center of the body to keep the organs warm. If this does not work, the body then begins to shiver. The shivering motion increases body heat because it is a form of movement. In a warm or hot environment, the hypothalamus detects an increase in blood temperature; blood vessels near the skin dilate, or widen, to bring more blood to the surface, which allows heat to escape. There are five general ways in which the body can be cooled: Radiation: heat is transferred from one object to another without physical contact. Convection: air moves over the skin and carries the skins heat away. Conduction: body is in direct contact with a substance that is cooler than the bodys temperature; the bodys heat is transferred to the cooler substance. Evaporation: a liquid or solid becomes a vapor. Respiration: air warmed by the lungs and airway is exhaled.
FACTORS AFFECTING BODY TEMPERATURE REGULATION

DISCUSSION
PRESENTATION: FACTORS AFFECTING BODY TEM PERATURE REGULATION
The three main factors affecting how well the body maintains normal body temperature are: Air temperature. Humidity. Wind.
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FACTORS AFFECTING BODY TEMPERATURE REGULATION Continued
Other factors, such as clothing, how often breaks are taken from exposure to extreme temperature, water intake and intensity of activity, affect how well your body manages temperature extremes. These factors can all be controlled to prevent heat-related illnesses or cold-related emergencies. Anyone can be at risk for a heat-related illness and cold-related emergency. However, some people are at greater risk than others. People more susceptible to a heat-related illness and cold-related emergency include those who: Work or exercise strenuously outdoors in a warm or hot and humid environment or a cold environment. Have a pre-existing health problem, such as diabetes or heart disease. Take medication to eliminate water from the body (diuretics). Consume other substances that have a diuretic effect, such as fluids containing caffeine, alcohol or carbonation. Do not maintain adequate hydration by drinking enough water to counteract the loss of fluids. Have had a previous heat-related illness or cold-related emergency. Live in a situation or environment that does not provide them with enough heating or cooling. Wear clothing inappropriate for the weather. Heat-related illnesses and cold-related emergencies occur more frequently among the elderly; young children and people with health problems are also at risk.
TOPIC:
ACTIVITY
HEAT-RELATED ILLNESSES

Time: 10 minutes
Ask the participants how many of them have experienced a situation in which someone was overcome by heat. Ask some of the participants to share with the class what happened and how the person was cared for. Record on a chalkboard or newsprint the signals the person displayed or described. The three conditions associated with overexposure to heat and loss of fluids and electrolytes include: Heat cramps. Heat exhaustion. Heat stroke. Dehydration is another condition often related to heat-related illnesses. If not recognized early and cared for promptly, they can get progressively worse in a very short period of time.
DISCUSSION PRESENTATION: HEAT-RELATED ILLNESSES
DEHYDRATION
DISCUSSION
PRESENTATION: DEHYDRATION
Dehydration refers to inadequate fluid in the bodys tissues and is often caused by inadequate fluid intake, vomiting, diarrhea, certain medications, and alcohol or caffeine use. The very young and very old are at highest risk for dehydration.
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34
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DRAFT
DEHYDRATION Continued
Lay responders can measure dehydration levels by monitoring urine color before, during and after a period of heavy work or exercise. Dark, amber urine or complete lack of urine output suggests a dehydrated state. Fluid loss that is not regained increases the risk for a heat-related illness. The signals of dehydration worsen as the body becomes dryer. Initial signals include: Fatigue. Weakness. Headache. Irritability. Nausea. Dizziness. Excessive thirst. Dry lips and mouth. As dehydration worsens, signals can include: Disorientation or delirium. Loss of appetite. Severe thirst. Dry mucous membranes. Sunken eyes. Dry skin that does not spring back if pinched, creating a tenting effect. Lack of tears (particularly important among young children). Decrease in perspiration. Dark, amber urine or complete lack of urine output. Unconsciousness. Care for a person who is dehydrated involves replacing the lost fluid. If the person is conscious and able to swallow, encourage him or her to drink small amounts of cool water or a commercial sports drink. Do not let the person gulp the fluid down; have him or her sip it at a slow pace. If dehydration is severe, the person will likely need more advanced medical care to receive fluids intravenously.
HEAT CRAMPS
DISCUSSION PRESENTATION: HEAT CRAM PS

Heat cramps are the least severe heat-related illness. The exact cause is unknown but thought to be a combination of loss of fluid and salt from heavy sweating. Heat cramps develop fairly rapidly and usually occur after heavy exercise or work in warm or even moderate temperatures. They are painful spasms of skeletal muscles, usually in the legs or abdomen, but they can occur in any voluntary muscle. The persons body temperature is usually normal and the skin is moist. Heat cramps may indicate that a person is in the early stages of a more severe heat-related illness. To care for heat cramps: Help the person move to a cool place to rest. Give an electrolyte- and carbohydrate-containing fluid, such as a commercial sports drink, fruit juice or milk. Water also may be given. Lightly stretch the muscle and gently massage the area.
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HEAT CRAMPS Continued
Do not give the person salt tablets, which could worsen the situation. When cramps stop, the person usually can start activity again if there are no other signals of illness. He or she should keep drinking plenty of fluids. Watch the person carefully for further signals of heat-related illness.
HEAT EXHAUSTION
DISCUSSION PRESENTATION: HEAT EXHAUSTION

Heat exhaustion is a more severe condition than heat cramps and results when fluid lost through perspiration is not replaced by other fluids. This results in the body pulling the blood away from the surface areas of the body to protect the vital organs. Signals of heat exhaustion include: Cool, moist, pale, ashen or flushed skin. Weakness. Dizziness. Shallow breathing. Exhaustion. Decreasing level of consciousness (LOC). Heavy sweating. Headache. Nausea. Muscle cramps. To give care: Move the person from the hot environment to a cooler environment with circulating air. Loosen or remove as much clothing as possible. Apply cool, wet cloths, such as towels or sheets, taking care to remoisten the cloths periodically. Spraying the person with water and fanning can also help. If the person is conscious and able to swallow, give him or her small amounts of a cool fluid such as a commercial sports drink or fruit juice to restore fluids and electrolytes. Milk or water may also be given. Do not let the conscious person drink too quickly. Let the person rest in a comfortable position and watch carefully for changes in his or her condition. Do not allow the person to resume normal activities the same day. If the persons condition does not improve or he or she refuses fluids, has a change in consciousness or vomits, call 9-1-1 or the local emergency number, as these are indications that the persons condition is getting worse. Stop giving fluids and place the person on his or her side in the H.A.IN.E.S recovery position if needed. Watch for signals of breathing problems. Keep the person lying down and continue to cool the body any way you can.
HEAT STROKE
DISCUSSION PRESENTATION: HEAT STROKE

Heat stroke is the least common but most serious heat-related illness. Heat stroke is a life-threatening condition that most often occurs when people ignore the signals of heat exhaustion or do not act quickly enough to give care. Heat stroke develops when the body systems are so overwhelmed by heat that they begin to stop functioning. Sweating often stops because body fluids levels are low. When sweating stops, the body cannot cool itself effectively through evaporation.
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HEAT STROKE Continued

Body temperature rises quickly, soon reaching a level at which the brain and other vital organs begin to fail. Two types of heat stroke are typically reported: Classic heat stroke: normally caused by environmental changes and often occurs during the summer months. It develops slowly over a period of days with persons presenting minimally elevated core temperatures. Exertional heat stroke: occurring when excess heat is generated through exercise and exceeds the bodys ability to cool off. Factors such as high air temperatures, high relative humidity and dehydration increase the risk. The signals of heat stroke include: Extremely high body temperature, above 104oF or 40oC. Flushed or red skin that can be either dry or moist. Rapid, shallow breathing. Throbbing headache. Dizziness, nausea or vomiting. Confusion. Changes in LOC. Seizures. If a person develops heat stroke, call 9-1-1 or the local emergency number immediately for heat stroke as it is a life-threatening emergency. While waiting for help to arrive, you will need to cool the person by following these steps: Preferred method: Rapidly cool the body by immersing the person up to the neck in cold water, if possible. Alternatively, cover the persons entire body in towels soaked with ice water, frequently rotating the cold, wet towels, spraying with cold water, fanning the person or covering the person with ice towels or bags of ice placed over the body. If you are not able to measure and monitor the persons temperature, apply rapid cooling methods for 20 minutes or until the persons condition improves. Give care according for other conditions found. A person in heat stroke may experience respiratory or cardiac arrest. Be prepared to perform CPR, if needed.
TOPIC:
COLD-RELATED EMERGENCIES
Time: 10 minutes
DISCUSSION PRESENTATION: COLD-RELATED EM ERGENCIES ACTIVITY
Frostbite and hypothermia are two types of cold-related emergencies. Frostbite occurs in body parts exposed to the cold. Hypothermia develops when the body can no longer generate sufficient heat to maintain normal body temperature. Ask the participants how many of them have experienced a situation in which someone was overcome by cold. Ask some of the participants to share with the class what happened and how the person was cared for. Record on a chalkboard or newsprint the signals the person displayed or described.
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DRAFT
FROSTBITE
DISCUSSION PRESENTATION: FROSTBITE

Frostbite is the freezing of body tissues, which usually occurs in exposed areas of the body, depending on: Air temperature. Length of exposure. Wind. Frostbite can be either superficial or deep. Superficial frostbite occurs when the skin is frozen but the tissues below are not. Deep frostbite involves the freezing of both the skin and the underlying tissues. Body cells are damaged or destroyed when fluid in and between cells freezes and swells. The ice crystals and swelling damage or destroy the cells. The signals of frostbite include: Lack of feeling in the affected area. Swelling. Skin that appears waxy, is cold to the touch and is discolored (flushed, white, yellow or blue). In more serious cases, blisters may form and the affected part my turn black and show signs of deep tissue damage. When giving care for frostbite, the priority is to get the person out of the cold. Once removed from the cold, Handle the area gently; never rub a frostbitten area. Rubbing causes further damage to soft tissues. Do not attempt to rewarm the frostbitten area if there is a chance that it might refreeze or if you are close to a medical facility. For minor frostbite, rapidly rewarm the affected part using skin-to-skin contact, such as with a warm hand. For more serious frostbite: Gently soak the area in water not warmer than about 105 F. If you do not have a thermometer, test the water temperature yourself. If the temperature is uncomfortable to your touch, it is too warm. Keep the frostbitten part in the water until normal color returns and it feels warm (20 to 30 minutes). Loosely bandage the area with a dry, sterile dressing. If fingers or toes are frostbitten, place dry, sterile gauze between them to keep them separated. Avoid breaking any blisters. Take precautions to prevent hypothermia. Monitor the person and care for shock. Do not give ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs). Call 9-1-1 or the local emergency number or seek emergency medical care as soon as possible.
HYPOTHERMIA
DISCUSSION PRESENTATION: HYPOTHERM IA
Hypothermia is the state of the body being colder than the usual core temperature, usually caused by excessive loss of body heat and/or the bodys inability to produce heat. Body temperature drops below 95oF (35o C). As the body cools, an abnormal heart rhythm (ventricular fibrillation) may develop and the heart will eventually stop. The person will die if not given care.
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HYPOTHERMIA Continued

The air temperature does not have to be below freezing for people to develop hypothermia. Anyone can develop hypothermia; predisposing factors include: A cold environment. A wet environment. Wind. Agethe very young or very old. Medical conditions Alcohol, drugs and poisoning. The signals of hypothermia include: Shivering (may be absent in later stages of hypothermia). Numbness. Glassy stare. Apathy or decreasing LOC. Weakness. Impaired judgment. Changes in LOC, unresponsiveness. Call 9-1-1 or the local emergency number immediately for any suspected case of hypothermia. The priority is to move the person to a warmer environment, if possible, being careful to move the person gently because any sudden movement can cause a heart arrhythmia and possible cardiac arrest. Give care as follows: In cases of severe hypothermia, the person may be unconscious, breathing may have stopped or slowed; check for breathing for no more than 10 seconds and perform CPR if needed. Continue to take steps to warm the person until EMS personnel take over. Make the person comfortable. Remove any wet clothing and dry the person. Put dry clothing on the person. Warm the body gradually by wrapping the person in blankets and plastic sheeting to hold in body heat. Also, keep the head covered to further retain body heat. If you are far from medical care, position the person near a heat source or apply heat pads or other heat sources to the body, such as containers filled with warm water. Carefully monitor any heat source to prevent burning the person. If the person is alert and can swallow, give warm liquids that do not contain alcohol or caffeine. Do not warm the person too quickly, such as by immersing the person in warm water. Do not rub or massage the extremities. Check breathing and monitor for any changes in the persons condition and care for shock. Be prepared to perform CPR or use an automated external defibrillator.
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DRAFT TOPIC:
PREVENTING HEAT-RELATED ILLNESSES AND COLD-RELATED EMERGENCIES

Time: 10 minutes
DISCUSSION PRESENTATION: PREVENTION
Emergencies resulting from overexposure to extreme temperatures are usually preventable. You can prevent overexposure to extreme temperatures by following these guidelines: Avoid being outdoors in the hottest or coldest part of the day. Dress appropriately for the environment and activity level. Change your activity level according to the temperature and take frequent breaks. Drink large amounts of nonalcoholic and decaffeinated fluids before, during and after activity. Plan to drink fluids when you take a break. Do not drink beverages containing caffeine or alcohol. When the weather is cold, layer your clothing. Read the following scenario aloud to the participants. Ask participants to identify ways the person in the scenario could have prevented this heat-related illness.
ACTIVITY PRESENTATION: PREVENTION
Instructors Note: If you are not using the PowerPoint slides, provide the participants with a written handout of the scenario. Scenario Twenty-year-old Todd Wilson is doing construction work for his uncle this summer. Todd is putting berglass insulation in an attic. He is wearing long pants, a long-sleeved shirt, goggles, a face mask and a hat to protect him from contact with berglass. Outdoor temperatures have been running about 95 F, and this day is exceptionally humid as well. Todd had hoped to have nished this job the evening before but has to return to the job around noon the next day. He expects that it will take about 5 hours to complete the work. Because Todd is in a hurry, he is working quickly to nish the job. He gures he can save some time if he does not take any breaks. About 2 hours later, drenched with sweat, Todd starts to feel dizzy, weak and nauseated. He barely has the energy to get down from the attic. Instructors Note: Responses should include the following: Not working during the hottest part of the day. Taking frequent breaks in a cooler environment (shade or air conditioning). Drinking large amounts of uid. Reducing the intensity of the work according to the temperature. When possible, removing heavy clothing to cool down.
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DRAFT TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Overexposure to extreme heat or cold may cause a person to develop a heat-related illness or cold-related emergency. The likelihood of this also depends on factors such as physical activity, clothing, wind, humidity, working and living conditions, and a persons age and physical condition. For heat-related illness, it is important for the person to stop physical activity. Cool the person and call 9-1-1 or the local emergency number. Heat stroke can rapidly lead to death if it is left untreated. Both hypothermia and frostbite are serious cold-related emergencies that require professional medical care. For both hypothermia and frostbite, it is important to warm the person gradually and handle him or her with care. Answer participants questions. Review Chapters 1019. Read Chapter 20 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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DRAFT 35
PUTTING IT ALL TOGETHER II/INJURIES AND SUDDEN ILLNESS

LESSON OBJECTIVES

To complete this lesson and meet the lesson objectives, you must: Conduct the scenarios to evaluate participants knowledge of the conditions and demonstration of proper rst aid skills in giving care.

Participants textbook Course Presentation: Part Five, Putting It All Together II/Injuries and Sudden Illnesses LCD projector, screen and computer Blankets or mats Triangular bandages Sterile gauze pads Roller bandages, gauze and elastic Nonlatex disposable gloves (multiple sizes) Skill Charts from Lessons 2534 Skill Assessment Tools from Lessons 2534 Written handouts of scenarios (optional)
TOPIC:
ACTIVITY
INTRODUCTION
Time: 5 minutes
Tell participants that they: Will split into several small groups with each group receiving a scenario to role-play using a participant as the injured or ill person. Will have approximately 5 minutes to prepare for the role-playing activity and that part of this preparation will include designating the roles each of the group members will assume based on the actual scenario assigned and gathering any necessary equipment and supplies. Are to formulate a response to the scenario integrating the discussion points and skills from Chapters 1019 and using the emergency action steps, CHECK-CALL-CARE, to guide their responses. Read the scenario aloud to the class before beginning to role-play the scenario. Should demonstrate any previously learned skills that would be required as part of the response, explaining their actions while providing care.
LESSON
35
Putting It All Together II/Injuries and Sudden Illness
239
DRAFT
Should be able to answer any questions asked by the instructor or other class members. Can explain their actions rather than demonstrate a skill if they feel it is necessary to use a skill that they have not yet learned. Will spend approximately 23 minutes after role-playing the scenario critiquing their actions and discussing any problems, errors or difficulties they may have had. Instructors Notes: If you are not using the PowerPoint slides, provide each group with a written handout of the scenario for reference. Due to time constraints, select three of the ve scenarios provided for participants to demonstrate. You may choose to select all ve scenarios and continue them at the beginning of the next lesson. When evaluating the participants responses, be sure they address the following: Did the groups plan follow the emergency action steps, CHECKCALLCARE? Did the plan involve bystanders appropriately? Did the plan demonstrate proper care?
TOPIC:
ACTIVITY
SCENARIO 1
Instructors Note:
Time: 13 minutes
This scenario addresses a conscious person with a serious head, neck or spinal injury. For this scenario, there should be one participant acting as the responder, one acting as the injured person, and one to two participants acting as bystanders.
Setup: At work, you are called to give care for a co-worker who has fallen from an 8-foot ladder. As you arrive, you see the injured person lying on the ground. She is crying and moaning in pain. A bystander says that she landed on her back. The injured person has not moved from this position. She says that she has tingling and numbness in her legs and feet and pain in her back. She also has a 2-inch laceration on the side of her head. You want to help. How do you proceed?
Instructors Note: The participants responses should include the following actions: Given that the cause of the injury suggests a serious head, neck or spinal injury, the responder should CALL 9-1-1 or the local emergency number immediately. The responder should rst CHECK the scene to see that it is safe. The responder should make sure nothing is going to fall, such as lights, boxes or what the person was working on. Because the person is conscious, the responder should begin a check by talking with and getting consent from the injured person. The injured persons cries and moans conrm that her airway is open and she is breathing. The responder should continue the CHECK step by interviewing the injured person and asking questions that would determine how she fell and where she was hurt.
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DRAFT
The responder should continue with a head-to-toe examination, being careful not to aggravate any injury and looking carefully for signals of a possible head, neck or back injury. A quick scan reveals a cut on the head, but bleeding is not severe. Bleeding from the side of the head should be controlled with direct pressure. The responder should begin CARE by providing manual stabilization for the injured persons head and neck. If there are bystanders who can help, they should be instructed to carefully apply direct pressure to the wound on the head to control bleeding. The responder should continue to monitor breathing and for any changes in condition, and take steps to minimize shock until EMS personnel arrive.
TOPIC:
ACTIVITY
SCENARIO 2
Instructors Note:
Time: 13 minutes
This scenario involves an unconscious person with an injured extremity. For this scenario, there should be one participant acting as the responder, one acting as the injured child and one or two participants acting as other members of the little league team.
Setup: You are coaching a little league baseball team. The pitcher is struck with a line drive to the ankle and falls to the ground. He is crying and in pain, unable to move the limb. Slight swelling and discoloration are already present. You are about 3 minutes away from the nearest hospital. The players parents are not at the game. You have a signed consent form from the parents to give care to all of the kids. You want to help. How do you proceed?
Instructors Note: The participants responses should include the following actions: Knowing that the scene is safe, a further CHECK of the scene is unnecessary. The responder should proceed with a CHECK of the injured player. Because the player is crying, the airway is open and he is breathing. The responder should continue the CHECK by completing a toe-to-head examination. Talk to the child to try to calm and reassure him. Whether to CALL 9-1-1 or the local emergency number for assistance or to transport the child yourself is a difcult decision. It should be based on several factors: Is an additional coach available to transport the injured pitcher or continue coaching and supervising the other members of the team while the responder transports the player? Is a phone available to call 9-1-1 or the local emergency number? Does the responder have adequate materials to immobilize the injured area before moving the player? Is it possible to move the player into a vehicle without further aggravating the injury? Can the parents or guardian be reached? The responder should begin to CARE for the injured player by immobilizing the injury, applying ice or a cold pack wrapped in a towel or gauze to control swelling and, if possible, elevating the injured area if it does not cause more pain.
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DRAFT TOPIC:
SCENARIO 3
Instructors Note:
Time: 13 minutes
This scenario involves a sudden illness. For this scenario, there should be one participant acting as the responder and one acting as the ill aunt.
Setup: For several hours, your 60-year-old aunt has been complaining of indigestion while at your home for a seafood cookout. She now says that she has severe stomach pain and feels nauseous. She thinks the pain and nausea relate to the food she ate. You notice that her skin is rather pale, she is breathing rapidly and she looks ill. You want to help. How do you proceed?
Instructors Note: The participants responses should include the following actions: Knowing that the scene is safe, a further CHECK of the scene is unnecessary. The responder should proceed with a CHECK of the aunts condition, beginning with talking to her to nd out what is wrong. The responder should get consent to help the aunt. Since she can speak, the airway is open and she is breathing. The responder should continue the CHECK by completing a head-to-toe examination. Though the responder might be thinking about food poisoning, there is no way to determine exactly what is wrong. However, it is unlikely that she is just having indigestion. The signals suggest that her condition is getting worse. Severe abdominal pain combined with her other signals is enough to warrant calling 9-1-1 or the local emergency number. The responder should begin to CARE for the aunt by having her stop any activity and rest in the most comfortable position, and continue to monitor her condition closely until EMS personnel arrive.
TOPIC:
ACTIVITY
SCENARIO 4
Instructors Note:
Time: 13 minutes
This scenario involves a heat-related illness. For this scenario, there should be one participant acting as the responder, one acting as the injured person and one or two participants acting as team members.
Setup: It is late in the afternoon, and your team is nishing its third match of the volleyball tournament on the beach. The day has been hot, with temperatures in the 90s. Suddenly, a teammate collapses. She does not appear to be fully conscious but is breathing rapidly. You notice that her skin is very warm, sunburned and moist. Her pulse is very fast. She is unable to get up from the ground. You want to help. How do you proceed?
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Instructors Note: The participants responses should include the following actions: An initial CHECK of the scene suggests that the heat is too intense. Consider moving your teammate immediately to a cooler environment if possible. Then, proceed with a CHECK by attempting to talk to her. Because she is not fully conscious, send a team member to CALL 9-1-1 or the local emergency number right away. Continue the CHECK by completing a head-to-toe examination. Begin CARE by removing her from the heat as quickly as possible, if you have not already done so. This might involve lifting and moving her, either by yourself or with the help of teammates. She should be taken to a shaded area, air-conditioned building, shower area or air-conditioned vehicle. If none of these are available nearby, she could be moved to the cool, wet sand near the water and shaded from direct sunlight. If lifeguards are nearby, ask them to assist. Attempt to cool the person, using wet towels, sheets or blankets. Since she is not fully conscious, do not give her any uids. You should place her on her side and maintain an open airway. Continue to monitor breathing and for any changes in condition until EMS personnel arrive.
TOPIC:
ACTIVITY
SCENARIO 5
Instructors Note:
Time: 13 minutes
This scenario involves substance abuse. For this scenario, there should be one participant acting as the responder, one acting as the injured person, and one to two participants acting as the friends.
Setup: A dangerous ritual is about to begin21 drinks for the 21st birthday. A group of close friends has gathered for a special party for the birthday boy. Everyone knows it is a dangerous game, but, because each of these friends went through it, they believe it is a rite of passage into adulthood. The activities begin, and the guest of honor is soon chugging beers and downing shots of liquor at a rapid pace. Two hours after the drinking began, you arrive at the party. The guest of honor is vomiting violently in the bathroom. He slumps to the oor and begins violent convulsions, and then stops moving. He seems to stop breathing and then takes a deep breath. You are called to help. How do you proceed?
Instructors Note: The participants responses should include the following actions: Knowing that the scene is safe, a further CHECK of the scene is unnecessary. The responder should proceed with a CHECK of the person beginning with a check for consciousness. Because the person is not fully conscious, the responder should send someone to CALL 9-1-1 or the local emergency number and continue the CHECK by determining if he shows signs of life or is bleeding severely. The responder should CARE for the conditions found and, if possible, consider removing him from the bathroom to a more open area with additional space.
LESSON
35
243
DRAFT

The responder should maintain an open airway and continue to monitor breathing and for any changes in condition until EMS personnel arrive. If the person is breathing normally, the responder should place the person in a recovery position.
TOPIC:
ACTIVITY
CLOSING

Time: 4 minutes
Briefly review the scenarios and the important elements of care. Answer participants questions. Read Chapter 20 and answer the questions at the end of the chapter.
ASSIGNMENT
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DRAFT
PART SIX
Special Situations
Lesson 36 Water-Related Emergencies, 246 Lesson 37 Pediatric, Older Adult and Special Situations, 253 Lesson 38 Emergency Childbirth (Optional), 265 Lesson 39 Disaster, Remote and Wilderness Emergencies I, 272 Lesson 40 Disaster, Remote and Wilderness Emergencies II, 279 Lesson 41 Putting It All Together III/Course Review, 286
PART SIX
Special Situations
245
LESSON
36
DRAFT
WATER-RELATED EMERGENCIES
LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe how to recognize a water emergency involving a distressed swimmer or a drowning victim. Understand what actions you can safely take to assist a person who is in distress or is drowning. Describe three nonswimming rescues and assists that you can use to help someone who is in trouble in the water. Describe how to use the head splint technique for a person who is unresponsive in the water or has a suspected head, neck or spinal injury in the water. Describe the general care for someone who has been involved in a drowning incident.

To complete this lesson and meet the lesson objectives, you must: Discuss drowning and the dangers associated with it. Conduct the activity for how to prevent aquatic emergencies. Describe how to recognize an aquatic emergency, a distressed swimmer, an active victim and a passive victim. Explain three nonswimming rescues and assists. Describe how to use the head splint technique. Describe care for unresponsive and responsive persons, including those with a suspected head, or spinal injury. Review how to help someone who has fallen through the ice.

Participants textbook Course Presentation: Part Six, Water-Related Emergencies Newsprint or chalkboard Markers or chalk
TOPIC:
INTRODUCTION

Time: 3 minutes
Drowning is one of the most common water-related emergencies. Drowning occurs when a person experiences respiratory impairment due to submersion in water. Drowning may or may not result in death; however, it is the fifth-most-common cause of death from unintentional injury in the United States among all ages, and it rises to the second leading cause of death among those 114 years of age. Approximately 4,500 Americans die annually from drowning, and an estimated 16,000 drowning incidents result in hospitalization, with many people suffering permanent disability. Children younger than 5 years of age and young adults between 15 and 24 years of age have the highest rates of drowning.
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DRAFT TOPIC:
WATER-RELATED EMERGENCIES
Time: 25 minutes
DISCUSSION PRESENTATION: WATER-RELATED EM ERGENCIES
A water emergency can happen to anyone in, on or around the water regardless of how good a swimmer the person is or what he or she is doing at the time. Some people who drown never intended to be in the water. A strong swimmer can get into trouble in the water because of sudden injury or illness. A nonswimmer playing in shallow ocean water can be knocked down by a wave or pulled into deeper water by a rip current. Someone can fall through the ice while skating on a pond. A child can drown at home in the bathtub, even in as little as an inch of water; or in a large bucket, the toilet or an irrigation ditch. Factors that increase the likelihood of a drowning incident include: Young children left alone or unsupervised around water. Use of alcohol and recreational drugs. Traumatic injury, such as from diving into a shallow body of water. Condition or disability, such as heart disease, seizure disorder or neuromuscular disorder that may cause sudden weakness or loss of consciousness while in the water. History of mental illness; for example, depression, suicide attempt, anxiety or panic disorder. Whether a person survives a drowning incident depends on many factors including how long he or she has been submerged and has been unable to breathe. Brain damage or death can occur in as little as 4 to 6 minutes when the body is deprived of oxygen. The sooner the drowning process is stopped, the better the persons chances for survival without permanent brain damage. The temperature of the water may also affect survival rates. People submerged in icy water have been successfully revived after a considerable period of time under the water. In cold water, body temperature begins to drop almost as soon as the person enters the water. Swallowing water accelerates this cooling. As the persons core temperature drops, body functions slow almost to a standstill and the person requires very little oxygen. Any oxygen in the blood is diverted to the brain and heart to maintain minimal functioning of these vital organs. Ask participants to review Chapter 20 and then have them provide suggestions for actions to take to prevent water-related emergencies. Write their responses on newsprint or the chalkboard. Compare their responses with the information presented in the textbook on preventing water-related emergencies.
ACTIVITY
Instructors Note: Participants responses should address the following guidelines: Learn to swim. Never leave children unattended or unsupervised around water. Proper supervision should be provided by an adult who is able to swim. Full attention must be given to the child/children in and around water. A child should always be within arms reach of an adult, whether in the bathtub or around some other body of water. Always swim with a buddy; never swim alone.
LESSON
36
Water-Related Emergencies
247
DRAFT
WATER-RELATED EMERGENCIES Continued

Read and obey all rules and posted signs, including no diving signs. Swim in areas supervised by a lifeguard. Children or inexperienced swimmers should take extra precautions, such as wearing a U.S. Coast Guard-approved life jacket when around the water. Watch out for the dangerous toostoo tired, too cold, too far away from safety, too much sun, too much strenuous activity. Be knowledgeable of the water environment and the potential hazards (deep and shallow areas, currents, depth changes, obstructions and where the entry and exit points are located). Use a feet-rst entry if you are unsure of any of these things. Do not mix alcohol with swimming, diving or boating. Alcohol impairs judgment, balance and coordination; affects swimming and diving skills; and reduces the bodys ability to stay warm. Learn how to dive safely from a qualied instructor. Never dive into an above-ground pool, the shallow end of any in-ground pool or head-rst into breaking waves at the beach. Never dive into cloudy or murky water. Do not run on a diving board or attempt to dive a long way through the air. The water might not be deep enough at the point of entry. If you are bodysurng, always keep your arms out in front of you to protect your head and neck.
RECOGNIZING AN AQUATIC EMERGENCY

DISCUSSION PRESENTATION: RECOGNIZING AN AQUATIC EM ERGENCY

Most people who are drowning cannot call out for help. There are three kinds of water emergency situations that can each be recognized by different behaviors. A distressed swimmer may be too tired to get to shore or the side of the pool but is able to stay afloat and breathe and may be calling for help. The person may be floating, treading water or clinging to a line for support. Someone who is trying to swim but making little or no forward progress may be in distress. If not helped, a distressed swimmer may lose the ability to float and become a drowning victim. An active victim could be at the surface of the water or sinking. The victim may be positioned vertically in the water and leaning back slightly. The victim may not have a supporting kick or ability to move forward. The victims arms could be at the side pressing down in an instinctive attempt to keep the head above water to breathe. All energy is going into the struggle to breathe, and the victim may not be able to call out for help. A passive victim may have a limp body or convulsive-like movements. He or she could be floating face-up or face-down near the surface of the water, or may be submerged.
Instructors Note: Refer participants to Table 20-1 in Chapter 20 in the textbook for a comparison of the behaviors seen in distressed swimmers and active and passive victims.
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DRAFT
TAKING ACTION
DISCUSSION PRESENTATION: TAKING ACTION

Consider your own safety above all else when faced with a water-related emergency. You should not attempt a swimming rescue unless you are trained to do so. Look for a lifeguard to help before attempting any water rescue. If a lifeguard or other professional responder is not present, make sure you have appropriate equipment for your own safety and that of the drowning victim. Call for help immediately if proper equipment is not available. Never swim out to a person unless you have the proper training, skills and equipment. If the drowning victim is unconscious, send someone to call 9-1-1 or the local emergency number while you start the rescue if possible.
Instructors Note: Refer participants to Chapter 20 in the textbook for additional factors that should be considered before attempting a water rescue.
NONSWIMMING RESCUES AND ASSISTS

DISCUSSION PRESENTATION: NONSWIM M ING RESCUES AND ASSISTS

You should make every effort to assist a person without entering the water. Start the rescue by talking to the person, letting him or her know that help is coming. Tell the person what you want him or her to do to help with the rescue. Ask the person to move toward safety by kicking or stroking his or her arms. Some people have reached safety by themselves with the calm and encouraging assistance of someone calling to them. If the person is close enough, you can use a reaching assist to help him or her out of the water. Firmly brace yourself on a pool deck, pier or shoreline and reach out to the person with any object that will extend your reach, such as a pole, oar or paddle, tree branch, shirt, belt or towel. If no equipment is available, you can still perform a reaching assist by lying down and extending your arm or leg for the person to grab while making sure that you are stable and cannot be inadvertently pulled into the water. Rescue a distressed swimmer or an active victim who is out of reach by using a throwing assist. Throw a floating object with a line attached, aiming so it lands just beyond the victim, with the line lying across the persons shoulder if possible. The victim can grasp the object and then be pulled to safety. Throwing equipment includes heavy lines, ring buoys, throw bags or any floating object available, such as a picnic jug, small cooler, buoyant cushion, kickboard or extra lifejacket. If the water is safe and shallow enough (not over your chest), you can use a wading assist to reach the victim. If there is a current or the bottom is soft or the depth unknown, making it dangerous to wade, do not enter the water. If possible, wear a life jacket and take something with you to extend your reach, such as a ring buoy, buoyant cushion, kickboard, life jacket, tree branch, pole, air mattress, plastic cooler, picnic jug, paddle or water exercise belt. If a passive victim is submerged in deep water, and a responder trained in water rescue is not on the scene, call 9-1-1 or the local emergency number for help immediately. If a passive victim is submerged in shallow water (less than chest deep), and a head, neck or spinal injury is not suspected, you can reach down and grab the victim to pull him or her to the surface. Once at the surface, turn the victim face-up and remove him or her from the water and provide care as described in the following sections.
LESSON
36
249
DRAFT
CARE FOR DROWNING
DISCUSSION PRESENTATION: CARE FOR DROWNING

A distressed swimmer or a person involved in any drowning incident should be removed from the water as soon as possible. However, how and when to remove the person depends on his or her overall condition (i.e., is the person conscious or unconscious; is a head, neck or spinal injury suspected), the persons size, how soon is help expected to arrive and whether anyone can help. The priorities in providing care in a water emergency are ensuring the persons face (mouth and nose) are out of the water, an open airway is maintained and resuscitation (when required) is begun as soon as possible. For a person who is unresponsive and face-down in shallow water, use the head splint technique to quickly turn the person face-up (if a head, neck or spinal injury is suspected, take care to minimize movement to the spine): Gently approach the person from the side. Move the persons arms up alongside the head by grasping the persons arms midway between the shoulder and elbow. Move the persons right arm with your right hand, and the persons left arm with your left hand. Squeeze the persons arms against the head. This helps keep the head in line with the body. Glide the person forward. Move slowly and rotate the person toward you until he or she is face-up. To rotate the person, push the persons closer arm under water while pulling the other arm across the surface toward you. In water with currents, hold the persons head upstream to keep the body from twisting. Position the persons head close to the crook of your arm, with the head in line with the body. If a person is unresponsive and face-up in shallow water, or if a spinal injury is suspected (even if the person is conscious), you will use a similar head splint technique as for a face-down person: Gently approach the persons head from behind, or stand behind the persons head. Lower yourself so that the water level is at your neck. Grasp the persons arms midway between the shoulder and elbow with your thumbs to the inside of each of the persons arms. Grasp the persons right arm with your right hand, and the persons left arm with your left hand. Gently move the persons arms up alongside the head while you reposition yourself to the persons side while trapping the persons head with his or her arms. Squeeze the persons arms against the head. This helps keep the head in line with the body. Do not move the person any more than is necessary. Position the persons head close to the crook of your arm, with the head in line with the body. Once an unresponsive person is face-up: Open the persons airway and check for breathing for no more than 10 seconds. If the person is breathing, and you suspect a head, neck or spinal injury, hold the person steady in the water until additional advanced help arrives. Do not lift the person or attempt to remove him or her from the water if additional help is anticipated. If the person is unconscious and there is no breathing, immediately remove the person from the water. Give 2 rescue breaths. If the chest clearly rises, immediately begin CPR with chest compressions. If the chest does not clearly rise with the first rescue breath, retilt the airway and give another rescue breath. If the chest still does not rise, use the modified CPR technique. If a head, neck or spinal injury is suspected, care should be taken to minimize movement to the spine, but priority must be given to airway management and giving CPR or modified CPR.
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CARE FOR DROWNING Continued
Remember that many persons who have been submerged vomit because water has filled the stomach or air has been forced into the stomach during rescue breaths. If the person vomits and is on dry land: Roll him or her into the modified H.A.IN.E.S. recovery position to prevent aspiration (or choking). Use a finger to remove the vomit from the mouth. If possible, use a protective barrier, such as disposable gloves, gauze or even a handkerchief. Roll the person on his or her back again and continue giving care as necessary. If the person vomits and is still in the water: Gently, partially roll the person while maintaining stabilization and clear the vomit. Be sure to keep the persons face out of the water. If the person you rescue is responsive and a head, neck or spinal injury is not suspected, help him or her to dry land (use a walking assist as taught in Chapter 3 if needed) and follow the CHECKCALLCARE steps to determine what care is needed. Always call 9-1-1 or the local emergency number when a person has been involved in a drowning incident, even if the person is responsive and you think the danger has passed. Complications can develop as long as 72 hours after the incident and may be fatal.
MOVING AN UNRESPONSIVE PERSON TO DRY LAND

DISCUSSION PRESENTATION: MOVING AN UNRESPONSIVE PERSON TO DRY LAND

If you are one a sloping shore or beach, you can use a beach drag to remove an unresponsive person from the water for the purpose of giving care. To perform the beach drag: Stand behind the person, and grasp him or her under the armpits, supporting the persons head, when possible, with your forearms. While walking backward slowly, drag the person toward the shore. Remove the person completely from the water or at least to a point where the persons head and shoulders are out of the water. You may also use a two-person beach drag if another person is available to help. The two-person lift can be used for removing a person from the water if there is no slope for you to easily remove the person. Do not use the two-person lift if you suspect the person has a head, neck or spinal injury unless you need to give CPR or modified CPR. To perform the two-person lift: Place the persons hands, one on top of the other, on the deck or overflow trough (gutter). Take the persons hands and pull him or her up slightly to keep the head above the water. Be sure the persons head is supported so that it does not fall forward and strike the deck. If in the water, climb out to help the second person. Each person grasps one of the persons wrists and upper arms. Lift together until the persons hips or thighs are at deck level. Step backward and lower the person to the deck. Protect the persons head from striking the deck. If necessary, pull the persons legs out of the water, taking care not to twist the persons back. Roll the person onto his or her back. Support the persons head and take care not to twist the persons body as it is rolled.
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HELPING SOMEONE WHO HAS FALLEN THROUGH ICE
DISCUSSION PRESENTATION: HELPING SOM EONE WHO HAS FALLEN THROUGH ICE

If a person falls through ice, never go out onto the ice yourself to attempt a rescue. It is your responsibility as a lay responder to call 9-1-1 or the local emergency number immediately. In the case of a drowning person, attempt to rescue the person using reaching and throwing assists. Continue talking to the person until help arrives. If you are able to safely pull the person from the water, provide care for hypothermia.
TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
Many drownings can be prevented by following simple precautions when in, on or around water. Use the basic methods of reaching, throwing or wading to reach or assist a person in the water without endangering yourself. Always remember to stay safe. If there is any chance that you cannot safely and easily help the person in trouble, call for professional assistance. When providing care in a water emergency, your first priority is ensuring that the persons face (mouth and nose) is out of the water and then giving appropriate care. If the person is unresponsive and face-up or face-down in shallow water, or when you suspect a head, neck or spinal injury, use the head splint technique to stabilize the persons head, neck and spine. If the unresponsive person is not breathing, remove the person from the water and give CPR or modified CPR based on what you find. If the person is responsive and no head, neck or spinal injury is suspected, help the person to dry land and use the emergency action steps CHECKCALLCARE to determine what care to take. Always call 9-1-1 or the local emergency number for a person involved in a drowning incident as potentially fatal complications can develop later. Further training in water safety and lifeguarding is available through redcross.org. Answer participants questions. Read Chapter 21 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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DRAFT 37
PEDIATRIC, OLDER ADULT AND SPECIAL SITUATIONS

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Describe considerations for checking an infant, a toddler, a preschooler, a school-age child and an adolescent. Explain how to observe an injured or ill child or infant and how to communicate with the parents or guardian. Describe the signals and care for common childhood illnesses and injuries. Describe how to check an older adult. Describe four problems that can affect older adults and their implications for care. Explain how to communicate with and assist a person with a physical disability or mental impairment. Explain options available when trying to communicate with a person but there is a language barrier. Explain what you should do if you encounter a crime scene or hostile person.

To complete this lesson and meet the lesson objectives, you must: Emphasize that participants may encounter emergencies involving individuals with special needs. Conduct the activity related to experiences with giving care to children and infants. Discuss the unique needs of children in different age groups and how these needs inuence the care to be given. Identify the common childhood injuries and illnesses. Describe the effects of aging, including the need to adapt communication and have awareness of potential age-related conditions. List the common injuries and illnesses in older adults. Discuss appropriate ways to facilitate communication with a person who has a hearing loss. Explain how to communicate with a person when a language barrier is involved. Emphasize the need for caution when giving care to a person in a crime scene or one that is hostile.

Participants textbook Course Presentation: Part Six, Pediatric, Older Adults and Special Situations Newsprint or chalkboard Markers or chalk
LESSON
37
Pediatric, Older Adult and Special Situations
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INTRODUCTION
Time: 3 minutes
In an emergency, individuals such as children, older adults, people with disabilities and people who do not speak, the same language you speak, have special needs and require unique considerations. Knowing these needs and considerations will help you give appropriate care. Being able to communicate with and reassure people with special needs is essential for you to care for them effectively.
TOPIC:
ACTIVITY
CHILDREN AND INFANTS

Time: 10 minutes
Ask participants to give examples of experiences they have had with ill or injured children or infants, including how they reacted emotionally. Reinforce the concept that people tend to react more strongly and emotionally to a child and that lay responders, like themselves, need to control their emotions and facial expressions and try to imagine how the child feels.
COMMUNICATING WITH INJURED OR ILL CHILDREN OR INFANTS, PARENTS AND CAREGIVERS

DISCUSSION PRESENTATION: COM M UNICATIONS

When interacting with an injured or ill child or infant, reduce the childs anxiety and panic and gain the childs trust and cooperation, if possible. Move in slowly, getting as close to the childs or infants eye level and keeping your voice calm. Smile at the child, ask the childs name and use it when talking with him or her. Talk slowly and distinctly, using words and asking questions that the child can easily understand and answer. Explain to the child and the parents or guardian what you are going to do, and that you are there to help and will not leave him or her. Remember that if the family is excited or agitated, the child is likely to be too. Calm the family; this will often help to calm the child, too. Get consent to give care from any adult responsible for the child.
CHARACTERISTICS OF CHILDREN AND INFANTS

DISCUSSION PRESENTATION: CHARACTERISTICS OF CHILDREN AND INFANTS

Children act differently depending on their age group. Children up to 1 year of age are referred to as infants. Infants under 6 months of age are relatively easy to approach and are unlikely to be afraid of you. Older infants may experience stranger anxiety, possibly turning away from you and crying and clinging to a parent or guardian. Try to check the infant in the parents or guardians lap or arms if the parent or guardian is calm and cooperative.
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CHARACTERISTICS OF CHILDREN AND INFANTS Continued
Children between ages 1 and 2 years are referred to as toddlers. They may not cooperate with attempts to check them and are usually very concerned about being separated from a parent or guardian. They need reassurance that they will not be separated from a parent or guardian, so give them a few minutes to get used to you before attempting to check them, and try to check them while they are in the parents or guardians arms or lap. A toddler may also respond to praise or be comforted by holding a special toy or blanket. Children between the ages of 35 years are referred to as preschoolers. Children in this age group are usually easy to check if you use their natural curiosity. Allow them to inspect items such as bandages. Reassure them that you are going to help and will not leave them. Sometimes, use a stuffed animal or doll to show what you are going to do. Cover any cuts or other injuries with a dressing as soon as possible because the child may be upset by seeing it. School-age children are between 612 years of age. They are usually cooperative and can be a good source of information. Do not let the childs chronological age influence how you expect an injured or ill child to behave in a way consistent with that age. Be especially careful not to talk down to these children. Let them know if what you are going to do is anything that may be painful. They are becoming conscious of their bodies and may not like exposure. Make every effort to respect their modesty. Adolescents are between the ages of 13 to 18 years and typically act more like adults than children. Direct questions to the adolescent rather than to a parent or guardian but do allow input from a parent or guardian. Keep in mind that you may not get an accurate idea of what happened or what is wrong if a parent or guardian is present. Remember that adolescents are modest and often respond better to someone of the same gender.
OBSERVING CHILDREN AND INFANTS

DISCUSSION PRESENTATION: OBSERVING CHILDREN AND INFANTS

You can obtain a lot of information by observing the infant or child before touching him or her. Look for signals that indicate changes in the level of consciousness, any trouble breathing and any apparent injuries and conditions. Often a parent or guardian will be holding a crying infant or child. In this case, check the child while the adult continues to hold him or her. Begin your check of a conscious child at the toe rather than the head. Checking this way is less threatening to the child and allows him or her to watch what is going on and take part in it. Ask a young child to point to any place that hurts. An older child can tell you the location of painful areas. If you need to hold an infant, always support the head when you pick him or her up.
LESSON
37
255
DRAFT TOPIC:
COMMON CHILDHOOD INJURIES AND ILLNESSES
Time: 10 minutes
ABDOMINAL PAIN
DISCUSSION PRESENTATION: ABDOM INAL PAIN

Abdominal pain in children can be the signal of a large range of conditions. Most are not serious and usually go away on their own. Abdominal pain accompanied by any of the following signals could indicate that the child is suffering from a serious condition or illness: A sudden onset of severe abdominal pain or pain that becomes worse with time Excessive vomiting or diarrhea Blood in the vomit or stool A bloated or swollen abdomen A change in the childs level of consciousness, such as drowsiness or confusion Signals of shock Call 9-1-1 or the local emergency number if you think the child has a life-threatening condition. While waiting for help to arrive: Help the child rest in a comfortable position Keep the child from becoming chilled or overheated Comfort and reassure the child Give care based on any conditions found.
CHILD ABUSE
DISCUSSION PRESENTATION: CHILD ABUSE
Child abuse is the physical, psychological or sexual assault of a child resulting in injury and emotional trauma. It involves an injury or pattern of injuries that do not result from an accident. Child neglect is a type of child abuse in which the parent or guardian fails to provide the necessary age-appropriate care to a child. Signals of child abuse include: An injury that does not fit the description of what caused the injury. Obvious or suspected fractures in a child younger than 2 years of age or any unexplained fractures. Bruises and burns in unusual shapes. Injuries in various stages of healing, especially bruises and burns. Unexplained lacerations and burns, especially to the mouth, lips and eyes. Injuries to the genitalia; pain when the child sits down. More injuries than are typical for a child of that age. Signals of child neglect include: Lack of adult supervision. A child who looks malnourished. A child with poor hygiene (e.g., old, dirty diaper on). An unsafe living environment. Untreated chronic illness. The priority is to care for the childs injuries or illnesses. The child may be unwilling to talk about the incident in an attempt to protect the abuser. If you suspect abuse, explain your concerns to responding police officers or EMS personnel, if possible.
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CHILD ABUSE Continued
If you think you have reasonable cause to believe that abuse has occurred, report your suspicions to a community or state agency, such as the Department of Social Services, the Department of Child and Family Services or Child Protective Services. In some areas, certain professionals are legally obligated to report suspicions of child abuse, such as daycare workers or school employees. Contact your supervisor or mandated reporter for more information on reporting child abuse at your workplace.
DIARRHEA AND VOMITING

DISCUSSION PRESENTATION: DIARRHEA AND VOM ITING

Diarrhea, or loose stools, often accompanies an infection or other gastrointestinal issue in children. Vomiting can be frightening, but it is rarely a serious problem. Diarrhea and vomiting both can lead to dehydration and shock, especially in young children. Contact a health care provider if the child or infant has any of the following signals of serious diarrhea and vomiting: Diarrhea or vomiting persists (for more than a few days; in an infant, less than a day). The child is not replacing lost liquids or cannot retain liquids. The child has not had a wet diaper in 3 or more hours or, if older, has not had any urine output for more than 6 hours. The child has a high fever. The child has bloody or black stools. The child is unusually sleepy, drowsy, unresponsive or irritable. The child cries without tears or has a dry mouth. The child has a sunken appearance to the abdomen, eyes or cheeks, or, in a very young infant, has a sunken soft spot at the top of the head. The child has skin that remains tented if pinched and released. Keep in mind the following when caring for children and infants with diarrhea: If the infant will not tolerate his or her normal feedings or if a child is drinking less fluid than normal, add a commercially available oral rehydration solution specially designed for children and infants. Do not give over-the-counter anti-diarrhea medications to children younger than 2 years. Use these with the guidance of a health care provider in older children. Try to limit sugar and artificial sweeteners. Focus on a low-fiber diet. For a child in gastrointestinal distress, think B.R.A.T: bananas, rice, applesauce and toast. Tea and yogurt may also be considered. Keep in mind the following for children and infants who are vomiting: For a very young child or infant, lay the child on his or her side so that the child does not swallow or inhale the vomit. Halt solid foods for 24 hours during an illness involving vomiting and replace with clear fluids, such as water, popsicles, gelatin or an oral rehydration solution specially designed for children and infants. Introduce liquids slowly. For instance, wait 2 to 3 hours after a vomiting episode to offer the child some cool water. Offer 1 to 2 ounces every half hour, four times. Then alternate 2 ounces of rehydration solution with 2 ounces of water every 2 hours. After 12 to 24 hours with no vomiting, gradually reintroduce the childs normal diet.
LESSON
37
257
DRAFT
EAR INFECTIONS
DISCUSSION PRESENTATION: EAR INFECTIONS

Ear infections are common in young children. Nearly 90 percent of young children have an ear infection at some time before they reach school age. Common signals of an ear infection include: Pain. Older children can tell you that their ears hurt, but younger children may only cry or be irritable or rub or tug on the affected ear. Fever. Ear drainage. Trouble hearing. Loss of appetite. Trouble sleeping. Contact a health care provider if: The childs signals last longer than a day. You see a discharge of blood or pus from the ear. This could indicate a ruptured eardrum. The child is having hearing problems. The childs signals do not improve or get worse after he or she has been diagnosed by a health care provider. Treat pain symptoms with ibuprofen or acetaminophen. In children younger than 2 years, watch for sleeplessness and irritability during or after an upper respiratory infection, such as a cold. Always consult with the childs health care provider before giving any over-thecounter pain relievers.
FEVER
DISCUSSION PRESENTATION: FEVER

Fever, an elevated body temperature above 100.4F, often indicates a specific problem in a child or infant. Usually these problems are not life threatening, but some can be. A high fever in a child or an infant often indicates some form of infection. In a young child, even a minor infection can result in a high fever, usually defined as a temperature 103F and above. A rapid rise in body temperature can result in seizures. A febrile seizure is a convulsion brought on by a fever in small children or infant. It is the most common type of seizure in children. Most febrile seizures are not life threatening but there are conditions where the child may require additional care. Aside from discovering a fever when checking a childs temperature, there are other signals that may indicate a fever is present. Older children with fever will often: Feel hot to the touch. Complain of being cold or chilled. Complain of body aches. Have a headache. Have trouble sleeping or sleep more than usual. Appear drowsy. Have no appetite. Infants with fever will often: Be upset or fussy, with frequent crying.
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DRAFT
FEVER Continued
Be unusually quiet. Feel warm or hot. Breathe rapidly and have a rapid heart rate. Stop eating or sleeping normally. Call 9-1-1 or the local emergency number if the child or infant has signals of life-threatening conditions, such as unconsciousness or trouble breathing. Also, call if this is the first time that a child has had a febrile seizure, the seizure lasts longer than 5 minutes or is repeated, or the seizure is followed by a quick rise in the temperature of the child or infant. Contact a health care provider for: Any infant younger than 3 months with a fever (100.4F or greater). Any child younger than 2 years with a high fever (103F or greater). Any child or infant who has a febrile seizure. Initial care for a child or infant with a high fever is to: Make him or her as comfortable as possible and encourage the child to rest. Make sure that the child or infant drinks clear fluids (e.g., water, juice) or continues nursing or bottle-feeding to prevent dehydration. Do not give the child aspirin for fever or other signals of flu-like or other viral illness. For a child, taking aspirin can result in an extremely serious medical condition called Reyes syndrome. If the child has a high fever, gently cool the child. Never rush cooling. If the fever caused a febrile seizure, rapid cooling could bring on other complications. Instead Remove any excessive clothing or blankets. Sponge the child with lukewarm water. Do not use an ice water bath or rubbing alcohol to cool down the body. Both of these approaches are dangerous.

Instructors Note: Refer participants to Chapter 15 in the textbook for information about how to care for febrile seizures.
INJURY
DISCUSSION PRESENTATION: INJURY

Injury is the number one cause of death for children over 6 months of age in the United States Many of these deaths result from motor vehicle crashes. The greatest dangers to a child or infant involved in a motor vehicle incident are airway obstruction and bleeding. A relatively small amount of blood lost by an adult is a large amount for a child or infant. Because a childs head is large and heavy in proportion to the rest of the body, the head is the most often injured area. A child or infant injured as a result of the force or a blow may also have damage to the organs in the abdominal or chest cavities, which can lead to severe internal bleeding. Try to find out what happened because a seriously injured child or infant may not immediately show signals of injury. Laws have been enacted to avoid needless deaths caused by motor vehicle crashes. Children and infants riding in the backseat of cars are to sit in approved safety seats or wear safety belts. If a child is in a safety seat and needs care, the seat does not normally pose any problems. Leave the child or infant in the seat if it has not been damaged. If the child or infant is to be transported to a medical facility, he or she can often be safely secured in the safety seat for transport.
LESSON
37
259
DRAFT
POISONING
DISCUSSION PRESENTATION: POISONING

Poisoning is one of the top ten causes of unintentional death in the United States for adolescents, children and infants. Children younger than 6 years account for half of all exposures to poisonous substances in the United States, most often from ingesting household products or medications (typically those intended for adults). Although children in this age group are exposed more often than any other, only 3 percent of these cases result in death.
Instructors Note: Refer participants to Chapters 16 in the textbook for information about how to care for poisoning and how to prevent poisoning of children in the home.
SIDS
DISCUSSION PRESENTATION: SIDS

Sudden infant death syndrome (SIDS) is the sudden, unexpected and unexplained death of apparently healthy babies. It is the third leading cause of death for infants between 1 month and 1 year of age, occurring most often in infants between 4 weeks and 7 months of age. SIDS usually occurs while the infant is sleeping. By the time the infants condition has been discovered, he or she will be in cardiac arrest. Make sure someone has called 9-1-1 or the local emergency number or call yourself. Perform CPR on the infant until EMS personnel take over, an automated external defibrillator (AED) becomes available or you see an obvious sign of life, such as breathing. An incident involving a severely injured or ill child or infant, or one who has died, can be emotionally upsetting. After such an episode, find someone you trust with whom you can talk about the experience and express your feelings. If you continue to be distressed, seek professional counseling.
TOPIC:
OLDER ADULTS

Time: 10 minutes
DISCUSSION PRESENTATION: OLDER ADULTS
Older adults, generally considered those people over 65 years of age, are quickly becoming the fastest growing age group in the United States. Normal aging brings about changes with body function generally declining with age. Lungs become less efficient. Amount of blood pumped by the heart with each beat decreases. Heart rate slows. Blood vessels harden, increasing the work of the heart. Hearing and vision usually decline. Reflexes become slower. Four out of five older adults develop some sort of chronic condition or disease. The physical and mental changes associated with aging may require you to adapt your way of communicating and to be aware of certain potential age-related conditions, such as hearing loss. To check an injured or ill older adult: Learn the persons name and use it when you speak to him or her. Be respectful. Use Mr., Mrs. or Ms. when addressing the adult. Position yourself at the persons eye level.
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DRAFT
OLDER ADULTS Continued
If the person appears confused at first, check to see if he or she uses any aids such as eyeglasses and attempt to locate them for the person. Speak slowly and clearly, and look at the persons face while you talk. Find out if the person is using medications or has known medical conditions. Recognize that the person may minimize signals of an injury for fear of losing his or her independence.
COMMON INJURIES OR ILLNESSES

PRESENTATION: COM MON INJURIES OR ILLNESSES

As a result of changes related to aging, many older adults are particularly susceptible to certain problems. Alzheimers disease affects the brain resulting in impaired memory and thinking and altered behavior. Most people affected are older than 65, however, it can strike people in their 40s and 50s. Signals develop gradually and include confusion, progressive memory loss, and changes in personality, behavior and the ability to think and communicate. Eventually persons become totally unable to care for themselves. Most people with Alzheimers disease are cared for by their families. Support services are available to help with giving care at home. Older adults are at increased risk for altered thinking patterns and confusion, some resulting from aging, disease, medication or injury. Confusion can be a signal of a medical emergency. Regardless of the reason, do not talk down to the person or treat the person like a child. Older adults are at increased risk for falls, with falls as the leading cause of death from injury for older adults. Falls frequently result in fractures because the bones become weaker and more brittle with age. Older adults also are at increased risk for head injuries. The size of the brain decreases with age resulting in more space between the surface of the brain and the inside of the skull. This space allows more movement of the brain within the skull, increasing the likelihood of serious head injury. Always suspect a head injury as a possible cause of a behavior change in an older adult unless you know the specific cause of that change. An older adult is more susceptible to extremes in temperature. The person may be unable to feel temperature extremes because his or her body may no longer regulate temperature effectively. Body temperature may change rapidly to a dangerously high or low level. The body of an older adult retains heat because of a decreased ability to sweat and the reduced ability of the circulatory system to adjust to heat. This can lead to heat exhaustion or heat stroke. An older adult may become chilled and suffer hypothermia simply by sitting in a draft or in front of a fan or air conditioner. Hypothermia can occur at any time of the year. People can go on for several days suffering from mild hyperthermia without realizing it. The older person with mild hypothermia will want to lie down frequently; however, this will lower the body temperature even further.
LESSON
37
261
DRAFT TOPIC:
PEOPLE WITH DISABILITIES
Time: 5 minutes
DISCUSSION PRESENTATION: PEOPLE WITH DISABILITIES
Disability is defined as someone with a physical or mental impairment that substantially limits one or more major life activities such as walking, talking, seeing, hearing or learning. General advice for approaching an injured or ill person who you have reason to believe may have a physical disability include the following: Speak to the person before touching him or her. Ask How can I help? or Do you need help? Ask for assistance and information from the person who has the disability. If the person is not able to communicate, ask any of his or her family members, friends or companions who are available. Do not remove any braces, canes, other physical support, eyeglasses or hearing aids. Look for a medical identification (ID) tag, bracelet or necklace at the persons wrist or neck. A person with a disability may have an animal assistant, such as a guide dog or hearing dog. Be aware that this animal may be protective of the person in an emergency situation. Someone may need to calm and restrain the animal. Allow the animal to stay with the person if possible, which will help reassure them both. Hearing loss, either partial or total, also can be problematic. The biggest obstacle is communication. You may not initially be aware that the injured or ill person has a hearing loss. Often the person will tell you, either in speech or by pointing to the ear and shaking the head no. Some people carry a card stating that they have a hearing loss. You may see a hearing aid in a persons ear. Vision loss involves partial or total loss of sight. It is no more difficult to communicate orally with a person who has a partial or total loss of sight than with someone who can see. Checking the person is the same as checking a person who has good vision. When caring for a person with vision loss: Help to reassure him or her by explaining what is going on and what you are doing. If you must move a visually impaired person who can walk, stand beside the person and have him or her hold onto your arm. Walk at a normal pace, alert the person to any obstacles in the way, such as stairs, and identify whether to step up or down. If the person has a seeing eye dog, try to keep them together. Ask the person to tell you how to handle the dog or ask him or her to do it. A person with motor impairment is unable to move normally. The person may view accepting help as failure and may refuse help to prove he or she does not need it. Determining which problems are pre-existing and which are the result of immediate injury or illness may be difficult. Care for all problems you detect as if they are new. Mental, or cognitive, function includes the brains capacity to reason and to process information. When caring for a person with mental impairment: Approach the person the same way you would anyone else in that age group. Listen carefully to what the person says. Explain who you are and what you are going to do. If a parent or guardian is present, ask that person to help you care for the person.
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PEOPLE WITH DISABILITIES Continued
People with certain types of mental illness might misinterpret your actions as being hostile. If the scene becomes unsafe, you may need to remove yourself from the immediate area. Call 9-1-1 or the local emergency number and explain your concerns about a potential psychiatric emergency. If possible, keep track of the persons location and what he or she is doing and report this information to the emergency responders.
TOPIC:
LANGUAGE BARRIERS

Time: 2 minutes
DISCUSSION PRESENTATION: LANGUAGE BARRIERS
Getting consent to give care can be difficult for a person who speaks in a language other than the one in which you are fluent. Find out if any bystanders speak the persons language and can help translate. Do your best to communicate nonverbally, using gestures and facial expressions if appropriate. When you call 9-1-1 or the local emergency number, explain that you are having trouble communicating with the person and say what nationality you believe the person is or what language he or she is speaking. The EMS system may have a translator available.
TOPIC:
CRIME SCENES AND HOSTILE SITUATIONS
Time: 3 minutes
DISCUSSION PRESENTATION: CRIM E SCENES AND HOSTILE SITUATIONS
In certain situations, such as giving care to a person in a crime scene or an injured person who is hostile, you will need to use extreme caution. Your first reaction may be to go to the aid of a person. Instead, call 9-1-1 and stay at a safe distance. Do not enter the scene of a suicide. If you happen to be on the scene when an unarmed person threatens suicide, call 9-1-1 or the local emergency number. Do not argue with the person. Leave or avoid entering any area considered to be a crime scene, such as one where there is a weapon, or the scene of a physical or sexual assault. Call 9-1-1 or the local emergency number and stay at a safe distance. Sometimes, a person may be hostile or angry, possibly due to the injury, pain or fear, loss of control, or due to the use of alcohol or other drugs, lack of oxygen or a medical condition. If a person refuses your care or threatens you, remove yourself from the situation and stay at a safe distance. Never try to argue with or restrain a person. Call 9-1-1 or the local emergency number if someone has not already done so. Never put your own safety at risk. If a family member displays anger: Try to remain calm and be sympathetic but firm, explaining what you are doing. Find a way that the family members can help, such as by comforting the person.
LESSON
37
263
DRAFT TOPIC:
CLOSING
Time: 2 minutes
DISCUSSION
To give effective care to an older adult, a child or an infant; a person with a disability; or anyone with whom communication is a challenge, you may need to adapt your approach and your attitude. Situations may also occur in which you should not intervene. If a situation is in any way unsafe, do not approach the person and if you have already approached, withdraw. If the situation is a crime scene, keep your distance and stay away and call for appropriate help. Answer participants questions. Read Chapter 22 and complete the questions at the end of the chapter. If you are not planning to teach Lessons 38 through 40, have participants review Chapters 1-21.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 38
EMERGENCY CHILDBIRTH (OPTIONAL)

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Understand the basics of pregnancy and the birth process. Describe the four stages of labor. Identify the factors to determine the mothers condition before the birth. Describe techniques the expectant mother can use to cope with labor pain and discomfort. Identify equipment and supplies needed to assist the delivery of a newborn. Describe how to assist the delivery of a newborn. Identify the priorities of care for a newborn. Describe the steps to take in caring for the mother after delivery. Identify possible complications during pregnancy and childbirth that require immediate medical care.

To complete this lesson and meet the lesson objectives, you must: Discuss the basic birth process. Identify the four stages of labor. Give examples of questions to ask a woman to determine whether she is in labor. Conduct the activity related to the scenario on assisting the delivery of a newborn. Identify caring for the newborn as the priority after birth. Discuss the care of the mother after delivery. Identify complications that may occur during pregnancy and during childbirth.

Participants textbook Course Presentation: Part Six, Emergency Childbirth Newsprint or chalkboard Markers or chalk Written handouts of scenario (optional)
TOPIC:
INTRODUCTION

Time: 3 minutes
Childbirth is a natural process. Thousands of children all over the world are born each day, without complications, in areas where no medical care is available. By following a few simple steps, you can effectively assist the birth process.
LESSON
38
Emergency Childbirth (Optional)
265
DRAFT TOPIC:
PREGNANCY AND THE BIRTH PROCESS

Time: 12 minutes
DISCUSSION
PRESENTATION: PREGNANCY AND THE BIRTH PROCESS
Pregnancy begins when an egg (ovum) is fertilized by a sperm, forming an embryo. The embryo implants itself within the lining of the mothers uterus, a pear-shaped organ that lies at the top center of the pelvis. The embryo is surrounded by the amniotic sac, also called the bag of waters. The fluid helps protect the newborn from injury and infection. As the embryo grows, its organs and body develop. After about 8 weeks, the embryo is called a fetus. To continue to develop properly, the fetus receives oxygen and nutrients from the mother through a specialized organ called the placenta, which also removes carbon dioxide and waste products. The placenta is attached to the lining of the uterus and is rich in blood vessels. The placenta is also attached to the fetus by a flexible structure called the umbilical cord. The fetus will continue to develop for approximately 40 weeks (calculated by counting back from the womens last menstrual cycle), at which time the birth process will begin. Pregnancy is broken down into three trimesters, each lasting approximately three months.
BIRTH PROCESS/LABOR
DISCUSSION

PRESENTATION: BIRTH PROCESS/ LABOR
Pregnancy culminates in labor (also called the birth process) during which the baby is delivered. For first-time mothers, this process normally takes between 12 and 24 hours. Subsequent deliveries usually require less time.
STAGES OF LABOR
DISCUSSION PRESENTATION: STAGES OF LABOR

The labor process has four distinct stages. The length and intensity of each stage varies. Stage OneDilation This stage covers the period of time from the first contraction until the cervix is fully dilated. A contraction is a rhythmic tightening of the muscles in the uterus to allow the mothers cervix to dilate, or expand enough for the baby to pass through the canal during the birth. A break occurs between contractions, and a contraction normally lasts about 30 to 60 seconds. As the time for delivery approaches, contractions occur closer together, last longer and feel stronger. Normally, when contractions are less than 3 minutes apart, delivery is near. Stage TwoExpulsion The second stage begins when the cervix is completely dilated and includes the babys movement through the birth canal and delivery. The mother will experience enormous pressure, similar to the feeling she has during a bowel movement. This sensation is an indication that it is time for her to push or bear down. Considerable blood may come from the vagina at this time. Contractions are more frequent and may last between 45 and 90 seconds each.
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DRAFT
STAGES OF LABOR Continued
When the top of the head begins to emerge, called crowning, birth is imminent. You must be prepared to receive the newborn. Stage two ends with the birth of the baby. Stage ThreePlacental Placenta This stage begins after the newborns body emerges. The placenta separates from the wall of the uterus and is expelled from the birth canal. This usually occurs within 30 minutes after the delivery of the newborn. Stage FourStabilization This final stage of labor involves the initial recovery and stabilization of the mother, and normally lasts 1 hour. The uterus contracts to control bleeding, and the mother begins to recover from the physical and emotional stress that occurred during childbirth.
ASSESSING LABOR
DISCUSSION PRESENTATION: ASSESSING LABOR
If you must care for a pregnant woman, you will want to determine whether she is in labor, what stage of labor she may be in and whether she expects any complications. You can determine these and other factors by asking a few key questions and making some observations: Has 9-1-1 or the local emergency number been called? Is this her first pregnancy? Does she expect any complications? Is there a bloody discharge (mucous plug)? Has the amniotic sac ruptured (or water broken)? What are the contractions like? Are they close together? Are they strong? When the contractions are 5 minutes apart or longer, there is still time to transport the woman to a medical facility if possible. If the contractions are 2 minutes apart, you will not have time to transport the woman, because the birth is imminent. If no one has called 9-1-1 or the local emergency number yet, immediately call. Does she have an urge to bear down or push? Is the baby crowning? Be aware that the woman may be experiencing Braxton Hicks contractions, or false labor contractions. False labor contractions do not get closer together, do not increase in how long they last and do not feel stronger as time goes on. False labor contractions tend to be sporadic while true labor has regular intervals of contractions. Because there is no real, safe way to determine if the labor is false, ensure that the woman is seen by advanced medical personnel.
LESSON
38
267
DRAFT TOPIC:
ASSISTING WITH DELIVERY

Time: 12 minutes
DISCUSSION PRESENTATION: ASSISTING WITH DELIVERY
If it becomes evident that the mother is about to give birth, you will need to help her through the birth process at least until emergency medical services (EMS) arrives. Remain calm and confident and try not to be alarmed by the loss of blood and body fluid, which are a normal part of the birth process. Prepare the mother by reassuring her that you are there to help. If necessary and possible, explain what to expect as labor progresses. Suggest specific physical activities that the mother can do that will help her muscles relax, offer a distraction from the pain of contractions and ensure adequate oxygen for her and the baby, including: Regulating her breathing by breathing in slowly and deeply through the nose and out through the mouth. Focusing on one object in the room while regulating her breathing. Many expectant mothers participate in childbirth classes that help them become more competent in techniques used to relax during the birth process. If this is the case, encourage the mother to use what she learned. Expect delivery to be imminent when you observe the following signals: Intense contractions are 2 minutes apart or less and last 6090 seconds. The womans abdomen is very tight and hard. The woman reports feeling the newborns head moving down the birth canal or has a sensation like an urge to defecate. Crowning occurs. The mother reports a strong urge to push. Assisting the delivery of the newborn is often a simple process. Your job is to create a clean environment and help guide the newborn from the birth canal, minimizing injury to the mother and newborn. Using the following scenario, ask participants to describe how they would assist the delivery of the newborn. Encourage the participants to refer to their textbook to assist their responses. Setup: A car pulls into your driveway. The driver jumps out screaming for help for his wife, who is in the back seat. The woman is 35 years old and full term in her pregnancy. Her contractions are less than two minutes apart. She says that the baby is coming and she feels the need to push. Her husband tells you this will be their fourth child. How do you respond?
ACTIVITY PRESENTATION: SCENARIO/ ASSISTING WITH DELIVERY
Instructors Note: Responses related to preparing the mother for delivery should include the following: Explain to the expectant mother that her baby is about to be born. Stay calm and condent. Explain that you are trained in rst aid and ask for consent to assist the delivery. Have the husband call 9-1-1 or the local emergency number. Position the mother so that she is lying on her back, with her knees bent, feet at and legs spread wide apart. Control the scene so that the woman will have privacy. Establish a clean environment for delivery by using clean sheets, blankets, towels, clothes, or if necessary, newspapers, placing these items over the mothers abdomen and under her buttocks and legs. Also keep a clean, warm towel or blanket handy to wrap the newborn.
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DRAFT
ASSISTING WITH DELIVERY Continued
Wear disposable gloves; if gloves are not available, try to nd some other item to use as a barrier, such as a plastic bag or plastic wrap secured around your hands. Wear protective eyewear and put something on over your clothing, if possible, to protect yourself from splashing uids. Other helpful items to gather include: A bulb syringe to suction secretions from the infants nose and mouth immediately after birth. Gauze pads or sanitary pads to help absorb secretions and vaginal bleeding. A large plastic bag or towel to hold the placenta after delivery. As crowning begins, place a hand on the top of the newborns head and apply light pressure, allowing the head to emerge slowly, not forcefully, to help prevent tearing of the vagina and avoid injury to the newborn. Ask the mother to stop pushing and instruct her to pant. This technique will help her stop pushing and help prevent a forceful birth. Once the head is out, the newborns shoulders should rotate with another push. Support the head as the shoulders and rest of the body pass through the birth canal. Slide your forenger along the newborns neck to see if the umbilical cord is looped around it. If it is around the neck, gently slip the cord over the newborns head. If this cannot be done, slip it over the newborns shoulders as they emerge. The newborn can slide through the loop. Guide one shoulder out at a time without pulling on the newborn. As the newborn emerges, use a clean towel to catch him or her because the newborn will be wet and slippery. Place the newborn on his or her side, between the mother and you so that you can give care without fear of dropping the newborn. If possible, note the time the newborn was born.
TOPIC:
CARING FOR THE NEWBORN AND MOTHER

Time: 8 minutes
DISCUSSION
Your first priority after delivery of the newborn is to take steps to care for the newborn. Once these steps are accomplished, you can care for the mother.
CARING FOR THE NEWBORN

DISCUSSION
PRESENTATION: CARING FOR THE NEWBORN
The first priority is to see that the newborns airway is open and clear. Always support the newborns head. Immediately clear the mouth and nasal passages thoroughly using a bulb syringe, or if that is not available, your finger or a gauze pad. If using a bulb syringe, clear the mouth first and then each nostril. Insert the tip of the bulb syringe no more than 11 inches into the newborns mouth and no more than inch into the newborns nostrils. If the baby does not spontaneously breathe or cry, flick the soles of his or her feet or rub the lower back to stimulate crying. Crying helps clear the newborns airway of fluids and promotes breathing.
LESSON
38
269
DRAFT
CARING FOR THE NEWBORN Continued
If the newborn does not begin breathing on his or her own within the first minute after birth, and stimulating the newborn as described above does not work, begin CPR. Your second priority to the newborn is to maintain normal body temperature. Dry and wrap the newborn in a clean, warm towel or blanket. Continue to monitor breathing and skin color. Place the wrapped baby on the mothers abdomen.
CARING FOR THE MOTHER

DISCUSSION PRESENTATION: CARING FOR THE MOTHER

Help the mother begin nursing the newborn if possible; this will stimulate the uterus to contract and help slow bleeding. As the uterus contracts, it will expel the placenta, usually within 30 minutes. Do not pull on the umbilical cord. Catch the placenta in a clean towel or container. It is not necessary to separate the placenta from the newborn. Gently clean the mother using gauze pads or clean towels and place a sanitary pad or a towel over the vagina. Do not insert anything in the vagina. Feel for a grapefruit-sized mass in the lower abdomen and gently massage the lower portion of the abdomen. Massage will cause the uterus to contract and slow bleeding. Keep the mother positioned on her back. Keep her from getting chilled or overheated, and continue to monitor her condition.
TOPIC:
COMPLICATIONS DURING PREGNANCY AND CHILDBIRTH
Time: 8 minutes
COMPLICATIONS DURING PREGNANCY

DISCUSSION PRESENTATION: COMPLICATIONS DURING PREGNANCY

Complications during pregnancy are rare, but they do occur. The nature and extent of most complications can only be determined by medical professionals, so you should not be concerned with trying to diagnose a particular problem. Instead, concern yourself with recognizing signals. Any persistent or profuse vaginal bleeding or bleeding in which tissue passes through the vagina during pregnancy or any abdominal pain is abnormal. If these signals occur, call 9-1-1 or the local emergency number. While waiting for EMS to arrive, place a pad or other absorbent material between the mothers legs and take steps to minimize shock, including: Helping the woman into the most comfortable position. Keeping her from becoming chilled or overheated.
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DRAFT
COMPLICATIONS DURING CHILDBIRTH
DISCUSSION PRESENTATION: COM PLICATIONS DURING CHILDBIRTH

Complications during childbirth require more advanced medical care. Call 9-1-1 or the local emergency number immediately. Persistent bleeding is the most common complication of childbirth and occurs for many reasons: The uterus fails to contract after delivery The uterus is stretched too much during pregnancy A piece of the placenta remains inside the uterus following delivery Abnormally long labors and multiple births also increase the risk of bleeding While waiting for EMS personnel to arrive: Take steps to absorb the blood. Do not pack the vagina with dressings. Keep the mother calm. Take steps to minimize shock. A prolapsed umbilical cord occurs when a loop of the cord protrudes from the vagina while the unborn baby is still in the birth canal. This condition can threaten the unborn babys life as he or she moves through the birth canal, compressing the cord and stopping the blood flow to the unborn baby. Have the expectant mother assume a knee-chest position to help take pressure off the cord while waiting for EMS personnel to arrive. A breech birth is one in which the baby is born feet- or buttocks-first. Support the newborns body as it leaves the birth canal while waiting for the head to deliver. Do not pull on the newborns body. When the newborns head is delivered, check the newborn for breathing and be prepared to give rescue breaths and CPR as necessary. Multiple births or delivery of more than one newborn are handled in the same manner as single births. The mother will have a separate set of contractions for each baby being born. There may also be a separate placenta for each baby, but not always. Remember, the risk of persistent bleeding increases with multiple births.
TOPIC:
CLOSING

Time: 2 minutes
DISCUSSION
When unexpected deliveries occur outside of a controlled environment, a mother may require your assistance. To assess the mothers condition before delivery and assist the delivery, be familiar with the four stages of labor and understand the birth process. By knowing how to prepare the expectant mother for delivery, assist the delivery and give proper care for the mother and newborn, you can help bring a new child into the world. Answer participants questions. Read Chapter 23 and complete the questions at the end of the chapter. If you are not planning to teach Lessons 39 and 40, have participants review Chapters 1-22.
ACTIVITY ASSIGNMENT
LESSON
38
271
LESSON
39
DRAFT
DISASTER, REMOTE AND WILDERNESS EMERGENCIES I

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Dene situations where lay responders modify rst aid skills for long-term management of the injured or ill person(s). Identify leadership and followership roles in extended care situations. Adapt the emergency action steps CHECKCALLCARE to incorporate scene management and long-term care of the injured or ill person. Describe the information to gather and consider when making a plan to get help. Identify evacuation considerations and describe four options for obtaining help when advanced care is delayed.

To complete this lesson and meet the lesson objectives, you must: Conduct the activity related to identifying emergency situations in which professional medical care may not be available within 30 minutes and the factors that require lay responders to think and act differently. Identify the role of the leader and follower in extended care situations. Discuss how to modify the emergency action steps of CHECKCALLCARE, addressing scene management and long-term care. Describe the four options for making a plan to get help when advanced care is delayed, describing specic areas to consider for each option.

LCD projector, screen and computer Participants textbook Course Presentation: Part Six, Disaster, Remote and Wilderness Emergencies I Newsprint or chalkboard Markers or chalk
TOPIC:
INTRODUCTION
Time: 3 minutes
You might encounter a situation where you are faced with a large disaster involving widespread destruction or large numbers of injured or ill people or an emergency that happens in a remote situation that requires extra consideration and efforts for giving first aid care. Even if you do not live in an area prone to natural disasters or you prefer to stay in more populated areas, you never know when extraordinary circumstances might lead to a sudden need for emergency care on a large scale basis or with limited resources. Emergency medical services (EMS) system relies on lay responders to activate the EMS system in an emergency, usually by calling 9-1-1 or local emergency number.
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DRAFT
But particularly in a disaster, remote or wilderness first aid situation, there are opportunities for lay responders to make life-preserving differences before advanced medical assistance becomes available by stabilizing injuries and illnesses or preventing further harm.
TOPIC:
DISASTER, REMOTE AND WILDERNESS EMERGENCIES

Time: 10 minutes
ACTIVITY
Ask participants to give examples of situations that would possibly involve help not being available within 30 minutes. Write their responses on newsprint or chalkboard.
Instructors Note: Responses should include situations such as: Traveling on a boat or plane in transit. Traveling on a remote highway or isolated road. Being on a rural farm. Camping or hiking. The occurrence of a tornado, earthquake, or other natural disaster. Winter hazard conditions. Human mistakes, criminal activity or terrorism. Pandemic u outbreak.
Then ask the participants what issues or factors might be involved in these situations that would require them to think or act differently.
Instructors Note: Responses would most likely include: Time and/or distance that prevents access to swift advanced medical help. The environment, weather, location or time of day creating hazards. Unavailability of EMS due to overwhelming need. Unavailability of EMS due to lack of workers or damaged equipment. Scene safety issues that demand special skills and resources. Lack of adequate rst aid equipment. Issues related to managing resources, people and your own well-being for an extended amount of time.
LEADERSHIP AND FOLLOWERSHIP

DISCUSSION
PRESENTATION: LEADERSHIP AND FOLLOWERSHIP
The leader who emerges in one emergency may not be the same leader in another type of emergency based on each individuals experience. A designated leader may also change if that person is the one who becomes injured or ill. The leader in an emergency may not be the person with the highest rank, position or age in the group but rather the person with the best training for the particular situation. The primary goal to do the greatest good for the greatest number in the shortest time and as safely as possible.
LESSON
39
Disater, Remote and Wilderness Emergencies I
273
DRAFT
DISASTER, REMOTE AND WILDERNESS EMERGENCIES Continued
Leaders work to: Control scene safety. Take a big-picture view of the scene. Care for life-threatening conditions and non-life-threatening conditions (directly or indirectly). Provide evacuation direction for the group. As much as a good leader depends on his or her own knowledge, skill, and experience, a good leader also depends on the cooperation and assistance of other people in the group. If someone else takes leadership, or you are in a situation where you are assisting EMS personnel with a major disaster response, be a good follower by assuming responsibility for tasks given to you. Ask pertinent questions. Provide the leader with information to make informed decisions If you are the leader, listen to the followers and their information and provide feedback to maintain the relationship and identify priorities.
TOPIC:
TAKING ACTION USING MODIFIED CHECKCALLCARE: CHECK

Time: 10 minutes
DISCUSSION PRESENTATION: USING MODIFIED CHECKCALL CARE: CHECK
In disaster, remote or wilderness emergencies, the emergency action steps of CHECKCALLCARE still apply. However you need to modify them to meet the special needs. General modifications include: Breaking up the CHECK action step into three separate components that give you the information to act: Check scene safety. Check the person or persons. Check resources. Recognizing that the CALL step will be more difficult and will require more information to be shared about the entire situation, not just the injured or ill person(s). Giving CARE for a longer term, which will also require additional skills. Each of these action steps needs a plan, based on what you see, hear, and feel, along with what you anticipate. Good judgment is imperative.
CHECK THE SCENE

DISCUSSION

PRESENTATION: CHECK THE SCENE
Check the entire scene to get a general impression of what happened. Look for dangers that could threaten your safety or the safety of the person(s), such as downed wires, unstable structures, potential presence of toxic fumes, falling rocks or tree limbs, difficult terrain or wild animals.
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CHECK THE SCENE Continued

Note any impending problems, such as a threatening storm or darkness. If you see any dangers, do not approach the person(s) until you have carefully planned how you will avoid or eliminate the danger to yourself and others. Make the scene safe if needed or remove the person(s) with an emergency move if you can do so without putting yourself or others in jeopardy.
CHECK THE PERSON OR PERSONS

DISCUSSION PRESENTATION: CHECK THE PERSON OR PERSONS

Once you are sure it is safe, approach the person carefully and check for life-threatening conditions, starting with consciousness. The steps to identify priorities are slightly different: First, check for airway, breathing and circulation, including checking for severe bleeding systematically from heat to toe and underneath clothing. Follow with checking for disability of the extremities by checking circulation, ability to move, and ability to sense in each hand or foot. The absence of any of the three could be a sign of a life-threatening head, neck or spinal injury. If the person has fallen or if you do not know how the injury occurred, assume that he or she has a head, neck or spinal injury. Finally, consider the environment and protect the person from further harm. Give care for any life-threatening conditions as you find them. Next, check the person for any other problems that are not life threatening but may become so over time using a second systematic and detailed assessment. Ask bystanders or the person questions that describe what is now happening and any history that may have caused the situation but not be obvious to you. Whenever possible, perform a head-to-toe check, even if the person is unconscious or is being treated for life-threatening conditions. Write down the information; if you have nothing to write with, make mental notes of the most important or unusual observations.
CHECK FOR RESOURCES

DISCUSSION PRESENTATION: CHECK FOR RESOURCES
Check the scene for resources, including people available to help, communication or signaling devices available, food and water, shelter, first aid supplies and means of transportation. While checking bystanders, make sure everyone else nearby is okay, as there may be other persons who are at risk (i.e., if one person is hypothermic then other bystanders may be cold too). Check the surrounding environment for conditions or developing conditions that could endanger you or the person(s) during the time it will take to get help. Note any conditions that would make it difficult for you to go get help. Also, consider whether you need to move the person(s) to prevent further harm.
LESSON
39
275
DRAFT TOPIC:
TAKING ACTION USING MODIFIED CHECKCALLCARE: CALL
Time: 18 minutes
DISCUSSION PRESENTATION: USING MODIFIED CHECKCALL CARE: CALL
The CALL step is divided into two phases: Making a plan for getting help Executing the plan Proper planning based on the needs of the injured or ill person(s), changing environmental conditions and the resources available will help guide you with what to do and in which order to do it. In a delayed-help situation, you have four options for getting help: Stay where you are and call, radio or signal for help. Send someone to go get help or leave the person alone to get help. Transport the person to help. Care for the person where you are until the person has recovered enough to move on his or her own. Consider all of the information gathered during the CHECK step about the conditions at the scene, the condition of the injured or ill person(s), and the resources available or needed before making the plan. To help decide on the best approach, ask yourself and others these questions: Is advanced medical care needed and if so, how soon? Is there a way to call from the scene for help or advice? If phone or radio communication is not possible, is there a way to signal for help? If there is no way to call for help, is it possible to go get help yourself? Is there a way to transport the person(s) to help? Is it possible to give care where you are until the person(s) can travel? Is it safe to wait for help where you are? You will discover that there is no best plan for getting help. You may have to compromise, reducing overall risk by accepting certain risks.
CALLING FOR HELP

DISCUSSION PRESENTATION: CALLING FOR HELP
If you have some means of quickly calling for help, such as a mobile phone or two-way radio, have all the necessary information gathered about the condition of the person(s) and your location readily available so that EMS or rescue personnel can plan their response. Give the dispatcher specific information about your location. Identify prominent landmarks and mark your area to help rescuers find your location, keeping in mind that some landmarks clearly visible during the day may not be visible at night or may have been destroyed by a disaster. Use flares as one way to mark your location however, do not use them in heavily wooded or dry areas that could ignite You may need to send someone to meet EMS personnel at a main road or easy-to-identify location and have him or her guide EMS personnel to the person(s). If you have no way to call for help and it is dangerous or impractical to use flares or send someone for help, you may have to improvise distress signals. Two of the most widely used general distress signals are: Signals in Threes (three shots, three flashes of light, three shouts, three whistles, or three smoky fires) Ground-to-air signals (signals in three or a large X marked on the ground). Smoke, mirrors, flare guns and whistles also create visual or auditory signals to attract responders.
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DRAFT
SENDING FOR HELP
DISCUSSION PRESENTATION: SENDING FOR HELP
If calling or signaling is not an option, such as in a remote area where no mobile service is available, consider sending two or three people to get help, making sure they have the following information: A note indicating the condition of the injured or ill person(s) A map indicating the location of the person(s) A list of other members in the group A list of available resources A description of the weather, terrain and access routes, if known A plan for immediate-future and long-term plans; possible contingency plans, if needed Make sure to send enough people to ensure safety and success in delivering the message. Also make sure those sent can lead rescuers back to the person. Use maps, charts, compasses or global positioning units to describe the location. Always mark the way so that you can return more easily with rescuers. Make sure to always leave behind enough trained individuals to care for the injured or ill person(s) while waiting for help. Before sending anyone for help, consider whether tasks at the scene require everyones help.
LEAVING A PERSON ALONE

DISCUSSION PRESENTATION: LEAVING A PERSON ALONE

Generally, it is not a good idea to leave an injured or ill person alone. However, if you are alone with the person, have no way to call or signal for help and are reasonably sure that no one will happen by, then you may decide that it is best to leave the person and go get help. Before leaving the person, follow these steps: Write down the route, the time you are leaving and when you expect to be back. Leave this information with the person. Provide for the injured or ill persons needs while you are gone, making sure the person has adequate food, water and a container to use as a urinal or bedpan. These items should be within the persons reach. Make certain that the person has adequate clothing and shelter and that he or she is protected from the ground. Recheck any splints or bandages and adjust them if necessary. Before leaving a conscious person, make sure he or she understands you are going for help and let him or her know when you expect to return. Be as reassuring and positive as the situation allows. If the person is unconscious or completely unable to move, place him or her in the modified H.A.IN.E.S. recovery position.
TRANSPORTING A PERSON TO HELP

DISCUSSION PRESENTATION: TRANSPORTING A PERSON TO HELP

In situations involving injury or sudden illness, it is usually best to have help come to you. Consider transporting a person(s) to help only if a vehicle or other means of transportation is available, rather than simply carrying the person(s). Factors to consider when deciding to move a person include the following: Extent of the injuries Distance to be traveled Availability of help at the scene
LESSON
39
277
DRAFT
TRANSPORTING APERSON TO HELP Continued

Do not attempt to move or transport a person with a suspected head, neck or spinal injury unless the scene is not safe or a potential for danger exists. If you decide to transport a person to help, plan the route you will follow. It is better to have a person besides the driver who will care for the person during transport. If possible, inform someone else of your route and alternate plans.
TOPIC:
CLOSING
Time: 4 minutes
DISCUSSION
In situations, such as those that may occur with disaster, remote and wilderness emergencies, you will need to be prepared to give care for a much longer time than usual. Use the emergency action steps of CHECKCALLCARE modifying them as follows: Checking the scene, the person, and resources in detail before calling for help. Developing a more detailed plan for getting help and caring for the person for the long-term. Getting help, which may involve calling for help, sending for help, leaving the person alone while you go for help, or transporting the person to help. Answer participants questions. Review Chapter 23 and complete the questions at the end of the chapter.
ACTIVITY ASSIGNMENT
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LESSON
DRAFT 40
DISASTER, REMOTE AND WILDERNESS EMERGENCIES II

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Identify special considerations for rst aid care in disaster, remote, or wilderness settings. List three general types of preparation for venturing into an environment where help may be delayed.

To complete this lesson and meet the lesson objectives, you must: Describe the care for conditions that may require rst aid in disaster, remote or wilderness emergencies. Identify how to protect an injured or ill person from the environment. Explain how to prepare for emergencies in disaster-prone area or delayed-help environment.

LCD projector, screen and computer Participants textbook Course Presentation: Part Six, Disaster, Remote and Wilderness Emergencies II
TOPIC:
INTRODUCTION
Time: 3 minutes
In a delayed-help situation, your plan for caring for each person in need extends from the initial stabilization of an injury or illness to long-term care of those issues and personal care. The best care possible, whether for a few minutes or a few hours, will come if you remain calm, use the information in all of the CHECKS to create a holistic plan and demonstrate good leadership or followership.
LESSON
40
Disaster, Remote and Wilderness Emergencies II
279
DRAFT TOPIC:
TAKING ACTION USING MODIFIED CHECKCALLCARE: CARE

Time: 15 minutes
DISCUSSION
PRESENTATION: USING MODIFIED CHECKCALL CARE: CARE
After completing the initial check of the person and giving care for the conditions found, continue to monitor the persons condition. Continuously monitor the breathing of a person who is unconscious or has an altered level of consciousness. Recheck the person about every 15 minutes until they are stable. If the person can answer questions, ask the person if his or her condition has changed. Watch for changes in skin appearance and temperature and level of consciousness. Recheck any splints or bandages, and adjust them if they are too tight or loose. If minutes turn into hours, provide a safe means for the person to eat, urinate and defecate; if hours turn into days, assess and care for wounds with infection. Keep a written record, noting any changes you find and the time the changes occur, along with a description of the care given.
FRACTURES, DISLOCATIONS, SPRAINS AND STRAINS

DISCUSSION

PRESENTATION: FRACTURES, DISLOCATIONS, SPRAINS AND STRAINS
Do not attempt to move a person with a serious musculoskeletal injury unless it is absolutely necessary. Do not attempt to move a person or allow the person to move without first splinting the injured part. If you must move or transport the person, splint the injured body part, making sure to continue to check the splinted area for feeling, warmth, and color about every 15 minutes and adjust the splint if necessary. Use the principles of RICE, repeating RICE 3 to 4 times a day for long-term care.
BLEEDING
DISCUSSION

PRESENTATION: BLEEDING
In delayed-help situations, use the same principles that you learned to control severe bleeding. Maintains direct pressure for at least 10 minutes to allow a blood clot to form. Long-term management of small and large wounds includes cleaning the wound with large amounts of clean water and protecting the wound from infection with ointents and dressings. Check the wound periodically for infection, and clean and redress it as needed. If direct pressure fails to control external bleeding on an extremity or if it is not possible, if professional medical help is not available or if it is delayed, apply a manufactured tourniquet if properly trained. Because of the dangers of using a tourniquet, and additional factors complicating delayed-help situations, it is recommended that any individual planning to be in a delayed-help situation get full training on the use of tourniquets to control bleeding, such as that offered in a specific wilderness first aid course.
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DRAFT
BURNS
DISCUSSION
Instructors Note: Refer the participants to Chapter 10 to review the care for burns.
PRESENTATION: BURNS
General steps for caring for a burn in a delayed-help environment are the same as in any other situation: Be careful not to use more water than necessary and focus the cooling only on the burned area. Hypothermia and shock are possible when cold water is used on large or serious burns, especially in a cold environment. In areas with limited water, you may need to reuse it, so plan ahead. Since the danger of infection is greater in delayed-help environments, keep a dressing over the cooled burn. Apply a thin layer of wound gel to the dressing first if available. If an emergency facility is more than a day away, redress the burn daily. Elevate burned areas about the level of the heart and keep the burned person from becoming chilled while treating for shock. Always monitor breathing and consciousness.
SUDDEN ILLNESS
DISCUSSION

PRESENTATION: SUDDEN ILLNESS
When caring for a person with sudden illness, follow the same procedures as if you were not in a delayed-help situation. For a person recovering from a diabetic emergency due to low blood sugar: Have the person rest after eating or drinking something sweet. If he or she does not show signs of improvement within 5 minutes, give the person water. Consider a fast evacuation. Never attempt to give an unconscious person anything to eat or drink. To care for a person experiencing a seizure: First, prevent additional harm. Then, complete a detailed check for injuries after the seizure ceases. Maintain the persons body temperature and help prevent shock.
SHOCK
DISCUSSION
PRESENTATION: SHOCK
With all injuries and illnesses in a delayed-help situation, it is likely you will have to give care for shock to minimize or delay its onset, while waiting for advance medical care. Remember that shock does not always occur right away, it may develop while you are waiting for help because of hidden illness or injury. Check for signals of shock every time you check the persons condition. For those in shock and medical care is more than 2 hours away, provide the conscious person cool water or clear juices, about 4 ounces or more, to sip slowly over 20 minutes for an adult, 2 ounces over 20 minutes for a child, or 1 ounce over 20 minutes for an infant. Do not give fluids if the person is unconscious, having seizures, has a serious head or abdominal injury, or if vomiting is frequent and sustained. For anaphylaxis or anaphylactic shock, be sure someone knows the location of necessary medication, such as oral antihistamines or injectable epinephrine, and knows how to use it. Transport a person who shows signals of anaphylactic shock, such as swelling and trouble breathing, to a medical facility as quickly as possible.
LESSON
40
281
DRAFT
HEAD, NECK AND SPINAL INJURIES
DISCUSSION

PRESENTATION: HEAD, NECK AND SPINAL INJURIES
If you suspect a head, neck or spinal injury, the goal and the care are the same as in any other emergency: prevent further injury by providing manual stabilization. Caring for a person with a head, neck or spinal injury who will be exposed to the elements for an extended period may be more difficult to do, as the person will not be able to maintain normal body temperature without your help. The person will also need help with drinking, eating, urinating and defecating. Help the person maintain normal body temperature by placing insulation underneath him or her or providing shelter from the weather. If two or more people are available, roll the person onto one side to place insulation underneath the body, being careful not to twist the head, neck or spine.
TOPIC:
DIFFICULT DECISIONS
Time: 5 minutes
DISCUSSION PRESENTATION: DIFFICULT DECISIONS
Dealing with a life-threatening condition when advanced medical care is not easily obtainable is one of the most emotionally draining and stressful situations you can face as a lay responder. The most difficult question of all in a delayed-help situation may be how long to continue resuscitation efforts if the condition of a person in cardiac arrest does not improve and advanced medical help is hours away. There are no simple answers; however, the following are some general principles that can help you decide. CPR is used to partially and temporarily substitute for the functions of the respiratory and circulatory systems. It is not designed for and is not capable of sustaining a persons life indefinitely. The persons survival depends largely on what caused the heart to stop in the first place. If the cause was a direct injury to the heart, such as from a heart attack or from crushing or penetrating trauma to the chest, little chance exists that the person will survive in a delayed-help environment, whether or not CPR is performed. If the heart is not injured but stops as a result of hypothermia, suffocation, a lightning strike, or drowning (especially in cold water), the persons heart has a better chance of starting. CPR can limit brain damage in case the heart starts and may even improve the chance that the heart will start. In such a case, CPR should be continued until one of the following occurs: You find an obvious sign of life, such as breathing. You are relieved by another trained responder. EMS personnel arrive and take over. You are too exhausted to continue. The scene becomes unsafe. If a person dies or is found dead, you will then need to manage the physical and emotional needs of yourself and the group. Try yourself, and encourage others, to begin functioning normally and take steps to decrease the intensity of the emotional experience. Notify authorities and protect the body. Document and do not disturb the area as best as possible.
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DRAFT TOPIC:
PROTECTION FROM THE ENVIRONMENT

Time: 10 minutes
DISCUSSION PRESENTATION: PROTECTION FROM THE ENVIRONM ENT
If help will be delayed, it is critical to protect the person(s) from environmental conditions, such as heat, cold, wind, rain, sleet or snow, while waiting. You may need to construct a shelter using whatever materials you have on hand.
PROTECTING THE PERSON


An injured or ill person who is not able to move may develop a heat-related illness or cold-related emergency that is life threatening. To keep the person from getting chilled or overheated, provide some type of insulation to protect the person. If the ground is dry, use cloth items, such as towels, blankets, clothing or sleeping bags, to insulate the person from the ground, or dry leaves or grass may serve as natural insulators. If the ground is wet, add a moisture barrier, like a waterproof tarp, raincoat or poncho, between the insulating material and the ground.
CONSTRUCTING A SHELTER

If the person is exposed to hot sun, rain, snow or chilling wind, provide an appropriate shelter. Bystanders may need protection and they may also be a good resource for constructing or finding shelter. The four basic types of shelters are: Natural shelters. Artificial shelters. Snow shelters. Tents and bivouac bags. A car can also be an effective shelter. If you are stranded, it is better to stay in your car than to go find help because it is generally more visible and offers some protection. If you need heat, you can run the heater for 15 to 20 minutes each hour. Make sure snow or ice does not block the exhaust pipe and cause carbon monoxide fumes to back up into the car. Leave the window opened a little to prevent carbon monoxide poisoning. Whether a shelter is natural or artificial, it should be well ventilated to prevent buildup of condensation or toxic fumes.
LESSON
40
283
DRAFT TOPIC:
PREPARATION FOR EMERGENCIES
Time: 10 minutes
DISCUSSION PRESENTATION: PREPARATION FOR EM ERGENCIES
If you live or work in a disaster-prone area or delayed-help environment, or plan to be in one, develop a plan for how you will prepare and respond to emergencies that may arise. Minor incidents can lead to major ones quickly and occur for a variety of reasons: Bad judgment Environmental conditions Equipment failure Although not all factors that contribute to incidents or accidents are avoidable, many can be prevented through adequate preparation, training and knowledge.
TYPES OF PREPARATION
PRESENTATION: TYPES OF PREPARATION

The three general types of preparation are knowledge, skills and equipment. Knowledge includes: Learning about the emergency care resources available and how to access them. Educating yourself on how to react in an emergency that may be common in the region where you live or travel. Familiarizing yourself with local geography, including landmarks and hazards. Knowing the people in the group you are living, working, or traveling with, to find out who has relevant training, and who might have special health concerns that put them at greater risk of an injury or illness. Skills preparation includes: Having proficiency in implementing disaster plans, and wilderness or survival techniques. Having the technical skills necessary to safely engage in certain activities. Knowing how to operate a two-way radio and how to call for help. Equipment preparation includes having the essentials of water, food, and shelter prepared and available to help keep people alive during long-term events. Equipment includes: Appropriate clothing for your location and activities. First aid supplies suitable for your activities and expected hazards. Devices for signaling and communication. First aid kits are also important as not all first aid materials can be improvised. The contents of a first aid kit should be modified to suit your particular needs, being adapted for: The environment. The setting. The season. The terrain. When preparing for disasters or extended trips, ensure an adequate supply of medicine for routine issues in the first aid or disaster kits. As a lay responder, you are not licensed to give medications. Ensure that you are adequately prepared by getting trained. Take courses, talk to others with experience. Look for books, magazines and web sites for information on how to be prepared for common weather or natural events in your intended destination and risks associated with any activity. Find out about local emergency resources, including the local emergency number if it is not 9-1-1. Incorporate practice to assess knowledge, skills and behaviors.
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DRAFT TOPIC:
CLOSING
Time: 2 minutes
DISCUSSION
The care you give a person in a delayed-help situation is the same as what you have learned previously. However, you will spend more time caring for the person and assisting with their personal needs. Regularly checking the persons condition while waiting for help and writing down any changes that you find are important in a delayed-help situation. You may also need to protect the person from heat and cold by constructing a shelter if help is delayed for an extended period. Adequately preparing yourself for a delayed-help environment includes: Early planning. Talking to people with experience. Researching your location. Finding out about local weather conditions and emergency resources. Planning your route and constructing plans to deal with emergencies should they arise. Answer participants questions. Review Chapters 123 and review the questions at the end of the chapters.
ACTIVITY ASSIGNMENT
LESSON
40
285
LESSON
41
DRAFT
PUTTING IT ALL TOGETHER III/ COURSE REVIEW

LESSON OBJECTIVES

To complete this lesson and meet the lesson objectives, you must: Conduct the scenarios to evaluate participants knowledge of the conditions and demonstration of proper rst aid skills when giving care.

Participants textbook Course Presentation: Part Six, Putting It All Together III/Course Review Adult, child and/or infant manikins (one for every two participants) Decontamination supplies Splinting devices Blankets or mats Triangular bandages Sterile gauze pads Roller bandages, gauze and elastic Nonlatex disposable gloves (multiple sizes) Skill Charts from Lessons 140 Skill Assessment Tools from Lessons 140 Written handouts of scenarios (optional)
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DRAFT TOPIC:
ACTIVITY
INTRODUCTION
Time: 7 minutes
Tell participants that they: Will split into several small groups, with each group receiving a scenario to role-play using a participant as the injured or ill person. Will have approximately 5 minutes to prepare for the role-playing activity, which will include designating the roles each of the group members will assume based on the actual scenario assigned and gathering any necessary equipment and supplies. Are to formulate a response to the scenario integrating the discussion points and skills from Chapters 123 and using the emergency action steps CHECKCALLCARE to guide their responses. Should read the scenario aloud to the class before beginning to role-play the scenario. Should demonstrate any previously learned skills that would be required as part of the response, explaining their actions while giving care. Should be able to answer any questions asked by the instructor or other class members. Can explain their actions rather than demonstrate a skill if they feel it is necessary to use a skill that they have not yet learned. Will spend approximately 23 minutes after role-playing the scenario, critiquing their actions and discussing any problems, errors or difficulties they may have had.
Instructors Notes: If you are not using the Presentation slides, provide each group with a written handout of the scenario for reference. Each role-play scenario will take about 12 minutes. Use the Instructor Prompt Guide at the end of this lesson to provide the prompts at each CHECK step and to help you evaluate the groups responses. When evaluating the participants responses, be sure they address the following: Did the groups plan follow the emergency action steps: CHECKCALLCARE? Did the plan involve bystanders appropriately? Did the plan demonstrate proper care?
TOPIC:
ACTIVITY
SCENARIO 1
Instructors Note:
Time: 12 minutes
This scenario addresses a conscious person who has vomited and collapsed. For this scenario, there should be one participant acting as the responder, one acting as the unconscious person, one person acting as the friend and one person acting as the neighbors grandson.
Setup: It is a perfect day for a cookout! You could not have asked for better weather. A friend has arrived early to help you prepare for the hungry crowd that will soon descend. Just when everything seems to be falling in place, you are distracted by a faint, distant call for help. It sounds like your neighbors grandson. You and your friend run toward the voice. As you arrive in your neighbors front yard, you see your neighbor, an older woman, lying on the ground. She had been gardening. She appears to be unconscious and to have vomited. A container of pesticides is nearby. You would like to help. How do you respond?
LESSON
41
Putting It All Together III/Course Review
287
DRAFT TOPIC:
SCENARIO 2
Instructors Note:
Time: 12 minutes
This scenario involves a conscious person who develops a sudden illness with chest pain. For this scenario, there should be one participant acting as the responder and one acting as the ill father.
Setup: The game you and your dad have waited for all season is about to begin. The outcome will determine who will play for this years national championship. As you both begin to settle in front of the TV for the next couple of hours, you notice that your dad is acting strangely. He does not appear to feel well. When you question him, he denies that anything is wrong. After 20 minutes or so, you notice that your dad is not paying attention to the game. He seems to be feeling worse. He is pale, sweating and appears to be having trouble breathing. He insists that it is only indigestion. You would like to help. How do you respond?
TOPIC:
ACTIVITY
SCENARIO 3
Instructors Note:
Time: 12 minutes
This scenario involves a person with an injury from a fall. For this scenario, there should be one participant acting as the responder and one acting as the injured person.
Setup: As you ride along the bike trail, you are tired but relaxed. You must have ridden at least 10 miles. Then, as you round a sharp curve, you abruptly swerve to avoid a young woman sprawled in the middle of the path. She appears to have been roller blading and fallen. She is in obvious pain and is cradling her bent arm close to her chest. You stop your bike. You would like to help. How do you respond?
TOPIC:
ACTIVITY
CLOSING

Time: 2 minutes
Answer participants questions. Explain how the final exam will be administered. Remind participants about any additional course completion requirements. Review Chapters 123.
ASSIGNMENT
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Instructors Manual
DRAFT
INSTRUCTOR PROMPT GUIDE

Putting It All Together
CHECK THE SCENE
Instructor Responder

Scene is safe. Approaches person Identifies himself or herself Obtains consent to help if person is conscious Finds out what happened Identifies the number of persons involved Check person(s)
OR

Scene is unsafe. Retreats to safety Call 9-1-1 or the local emergency number.
CHECK THE PERSON FOR LIFE-THREATENING CONDITIONS CONSCIOUSNESS

Person is conscious. Check head-to-toe. Check for signals of life-threatening conditions. If there are life-threatening conditions, call 9-1-1 or the local emergency number and care for the conditions you find. If no life-threatening conditions are found, look for signals of non-life-threatening conditions and care for the conditions you find.
OR

Person is unconscious. Call 9-1-1 or the local emergency number. Check for life-threatening conditions.
AIRWAY

Person is conscious, has an obstructed airway. Send someone to call 9-1-1 or the local emergency number. CareGive back blows and abdominal thrusts until the person can cough forcefully, speak, breathe or becomes unconscious.
OR

Adult is unconscious, has an obstructed airway. Call 9-1-1 or the local emergency number. CareOpen the persons airway and check signs of life for no more than 10 seconds. If the person is not breathing, give 2 rescue breaths. If breaths do not go in, reposition airway by tilting head further back. Pinch the nose shut and give 2 breaths again. If breaths do not go in, give 30 chest compressions, look for a foreign object and give 2 rescue breaths.
LESSON
41
289
DRAFT
AIRWAY Continued
If the chest does not clearly rise, continue cycles of 30 chest compressions, foreign object check/ removal and 2 rescue breaths until one of the following occurs: The object is removed and chest clearly rises with rescue breaths. The person starts breathing on his or her own. EMS personnel arrive and take over. The scene becomes unsafe. The rescuer is too exhausted to continue.
BREATHING
Instructor Person is breathing. OR Person is having trouble breathing. ORPerson is not breathing.

Responder
Complete the head-to-toe check. Care for conditions you find.
Call 9-1-1 or the local emergency number. CareContinue to monitor the person and give care for the conditions you find. Call 9-1-1 or the local emergency number. CareGive 2 rescue breaths.
OR

CIRCULATION

Person shows signs of life. CareFirst care for any life-threatening conditions you find. Then care for any conditions that may become life threatening.
OR
Person does not show signs of life.

Call 9-1-1 or the local emergency number. Care for the conditions you findbegin CPR.
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DRAFT
BLEEDING
Instructor Person is not bleeding. ORPerson is conscious and has no immediate life-threatening conditions.

OR
Person has minor bleeding. ORPerson has severe bleeding.
Responder
Complete the head-to-toe check. Care for conditions you find. Continue the head-to-toe check, looking for conditions that are not immediately life threatening, but could become so. Care for any conditions you find.
OR
Complete the head-to-toe check. CareFirst care for any life-threatening conditions. Call 9-1-1 or the local emergency number if any are found. Then check and care for any conditions that may become life threatening, including minor bleeding. Call 9-1-1 or the local emergency number. Care for severe bleeding: Cover the wound with a sterile dressing and apply direct pressure. Cover the dressing with a bandage. If bleeding still does not stop, apply additional pressure and bandage. Then check and care for any conditions that may become life threatening.
OR

LESSON
41
291
LESSON
42
DRAFT
FIELD EXERCISE (OPTIONAL)

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Demonstrate emergency care for persons with simulated injuries found in eld situations, incorporating the knowledge and skills learned in Chapters 123.

To complete this lesson and meet the lesson objectives, you must: Conduct the simulated injury scenarios. Evaluate the participants responses to the scenarios, including participants knowledge of the conditions and demonstration of proper rst aid skills used when giving care.

Participants textbook Adult, child and/or infant manikins (one for every two participants) Decontamination supplies Splinting devices Blankets or mats Triangular bandages Sterile gauze pads Roller bandages, gauze and elastic Nonlatex disposable gloves (multiple sizes) Additional props, such as ladder, car, bicycle Skill Charts from Lessons 140 Skill Assessment Tools from Lessons 140
TOPIC:
INTRODUCTION
Time: 3 minutes
DISCUSSION
Tell participants that they will split into several small groups, with each group being evaluated individually and as a group based on the scenarios that evaluate the knowledge and skills learned in this course. They will be evaluated using the skill charts found in their textbook.
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DRAFT TOPIC:
ACTIVITY
SCENARIOS
Time: 40 minutes
Establish three simulated injury scenarios: A motor-vehicle collision. A recreation-related injury. A work-related injury. Ensure that the scenarios allow the participants the opportunity to use skills that they have acquired as part of this course. Participants should be able to apply these skills in a manner that provides appropriate care to the persons involved. Make the scenarios as realistic as possible by providing the necessary props, such as a car, motorcycle, bike or ladder. Enlist the aid of co-instructors to help with testing and simulation. Use additional participants as injured persons; when possible, use moulage or makeup to add realism to injuries. Explain the scenario aloud to the class before participants begin to role-play the scenario. Allow 23 minutes for preparation and then approximately 10 minutes for conducting each scenario. Have the participants formulate a response to the scenario integrating the discussion points and skills from Chapters 123 and using the emergency action steps CHECKCALLCARE to guide their responses. Participants should be able to: Demonstrate any previously learned skills that would be required as part of the response, explaining their actions while giving care. Answer any questions asked by the instructor or other class members. Critique their actions and discuss any problems, errors or difficulties they may have had after role-playing the scenario.
Instructors Note: Each role-play scenario will take about 10 minutes. Use the Skill Assessment Tools to evaluate the participants performance as well as make sure they address the following: Did the groups plan of action follow the emergency action steps CHECKCALLCARE? Did the plan involve bystanders appropriately? Did the plan demonstrate proper care?
TOPIC:
ACTIVITY
CLOSING

Time: 2 minutes
Answer participants questions. Remind participants about any additional course completion requirements. Review Chapters 123. Prepare for the final written exam.
ASSIGNMENT
LESSON
42
Field Exercise (Optional)
293
LESSON
43
DRAFT
FINAL WRITTEN EXAM I: BEFORE GIVING CARE

LESSON OBJECTIVES
After completing the lesson, participants should be able to: Demonstrate understanding of the information presented in Chapters 15.

To complete this lesson and meet the lesson objectives, you must: Administer the examination. Acknowledge course participation and completion.

Final written exam (one for each participant) Answer sheets (one for each participant) Answer key Pencils
TOPIC:
ACTIVITY
FINAL WRITTEN EXAM
Time: 30 minutes
Tell participants: They will receive a written exam comprised of 20 questions related to Before Giving Care. At least 80 percent of the questions must be answered correctly to pass each written exam. They may not use the participants textbook or notes to find the answers. They have approximately 30 minutes to complete the exams. They should come to you or raise their hand when they have completed the exam or have any specific questions. Pass out the exams and answer sheets to the participants. Review the exam instructions: Write only on the answer sheet. Clearly mark all answers. Use a pencil to mark the answers in case participants would like to erase or change their answers. Check all answers before handing in the exams.
Instructors Note: Score the exams using the answer key located in Appendix I of this instructors manual. As a participant hands in an answer sheet, quickly grade the exam and return it to the participant so that he or she can review any missed questions.
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DRAFT
FINAL WRITTEN EXAM Continued
Keep in mind that the passing grade for each component is 80 percent. Participants must correctly answer the following for each applicable course: Before Giving Care (Core): 16 out of 20 questions. If time allows, discuss with the class any specic test items that were problematic. Collect all answer sheets and exams before the participants leave the class. If a participant fails the exam(s), ask him or her to see you after class to schedule a retest.
TOPIC:
ACTIVITY
CLOSING
Time: 5 minutes
Inform participants that they will receive their American Red Cross certificate if they have: Attended all class sessions. Participated in all course activities. Demonstrated competency in all required skills and scenarios. Correctly answered at least 80 percent or better in the appropriate sections on the written exams. Tell participants that they must take additional exams before receiving certificates in CPR/AED and first aid.
Instructors Note: For additional information on course completion criteria, see Chapter 4 of this manual. Also refer to this chapter for information on what you need to do at the end of this course.
LESSON
43
Final Written Exam I: Before Giving Care
295
LESSON
44
DRAFT
FINAL WRITTEN EXAM II: CPR/AED

LESSON OBJECTIVES
After completing the session, participants should be able to: Demonstrate understanding of the information presented in Chapter 6. Acknowledge course participation and completion.

To complete this lesson and meet the lesson objectives, you must: Administer the examination. Acknowledge course participation and completion.

TOPIC:
ACTIVITY
FINAL WRITTEN EXAM
Time: 30 minutes
Instructors Note: If you have a separate exam period of sufcient length, you may administer all exam components at the same time. Tell participants: They will receive two written exams comprised of 10 to 12 questions each related to the AED component for an adult or child and the appropriate CPR component. At least 80 percent of the questions must be answered correctly to pass each written exam. They may not use the participants textbook or notes to find the answers. They have approximately 30 minutes to complete the exams. They should come to you or raise their hand when they have completed the exam or have any specific questions. Give the exams and answer sheets to each participant. Review the exam instructions: Write only on the answer sheet. Clearly mark all answers. Use a pencil to mark the answers in case participants would like to erase or change their answers. Check all answers before handing in the exams.
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DRAFT
Instructors Note: Score the exams using the answer key located in Appendix I of this instructors manual. As participants hand in their answers sheets, quickly grade the exams and return it to the participant so that he or she can review any missed questions. Keep in mind that the passing grade for each component is 80 percent. Participants must correctly answer the following for each applicable course: AEDAdult or Child: 8 out of 10 questions CPRAdult: 8 out of 10 questions CPRChild: 8 out of 10 questions CPRInfant: 8 out of 10 questions CPRAdult, Child and Infant: 10 out of 12 questions If time allows, discuss with the class any specic test items that were problematic. Collect all answer sheets and exams before the participants leave the class. If a participant fails the exam(s), ask him or her to see you after class to schedule a retest.
TOPIC:
ACTIVITY
CLOSING

Time: 5 minutes
Tell participants when the final written exam for first aid is scheduled. Inform participants that they will receive their American Red Cross certificate if they have: Attended all class sessions. Participated in all course activities. Demonstrated competency in all required skills and scenarios. Correctly answered at least 80 percent or better in the appropriate sections on the written exams. Tell participants that their certificate will indicate the components completed: AEDAdult and Child and the appropriate CPR
Instructors Note: For additional information on course completion criteria, see Chapter 4 of this manual. Also refer to this chapter for information on what you need to do at the end of this course.
LESSON
44
Final Written Exam II: CPR/AED
297
LESSON
45
DRAFT
FINAL WRITTEN EXAM III: RESPONDING TO EMERGENCIES: FIRST AID

LESSON OBJECTIVES
After completing the lesson, participants should be able to:

Demonstrate understanding of the information presented in Chapters 123. Acknowledge course participation and completion.

To complete this lesson and meet the lesson objectives, you must:

Administer the examination. Acknowledge course participation and completion.

TOPIC:
ACTIVITY
FINAL WRITTEN EXAM

Instructors Note:
Time: 40 minutes
If you have a separate exam period of sufcient length, you may administer all exam components at the same time. Tell participants: They will receive a written exam comprised of 30 questions related to First Aid. At least 80 percent of the questions must be answered correctly for each component to pass the written exam. They may not use the participants textbook or notes to find the answers. They have approximately 40 minutes to complete the exams. They should come to you or raise their hand when they have completed the exam or have any specific questions. Give the exams and answer sheets to each participant. Review the exam instructions: Write only on the answer sheet. Clearly mark all answers. Use a pencil to mark the answers in case participants would like to erase or change their answers. Check all answers before handing in the exams.
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Instructors Manual
DRAFT
Instructors Note: Score the exams using the answer key located in Appendix I of this instructors manual. As a participant hands in the answer sheet, quickly grade the exam and return it to the participant so that he or she can review any missed questions. Keep in mind that the passing grade for each component is 80 percent. Participants must correctly answer the following for each applicable course: First Aid: 24 out of 30 questions If time allows, discuss with the class any specic test items that were problematic. Collect all answer sheets and exams before the participants leave the class. If a participant fails the exam(s), ask him or her to see you after class to schedule a retest.
TOPIC:
ACTIVITY
CLOSING
Time: 5 minutes
Inform participants that they will receive their American Red Cross certificate if they have: Attended all class sessions. Participated in all course activities. Demonstrated competency in all required skills and scenarios. Correctly answered at least 80 percent or better in the appropriate sections on the written exams. Tell participants that their certificate will indicate the component completed: Responding to Emergencies: First Aid
Instructors Note: For additional information on course completion criteria, see Chapter 4 of this manual. Also refer to this chapter for information on what you need to do at the end of this course. Inform participants about other courses and volunteer opportunities with the American Red Cross. Thank all participants for attending the course.
LESSON
45
Final Written Exam III: Responding to Emergencies: First Aid
299
DRAFT
DRAFT
Appendices
Appendices
301
APPENDIX
DRAFT
SCENARIO WORKSHEETS

Adult CPR Scenarios 1 and 2 Child CPR Scenarios 1 and 2 Infant CPR Scenarios 1 and 2 AED Scenarios 1 and 2 First Aid Scenarios 1 and 2
ADULT CPR SCENARIOS 1 AND 2

Setup: Scenario 1 You are at a conference with several co-workers. One of your co-workers, Mara, has been complaining of chest pains since lunch, which she blamed on indigestion. Suddenly, Mara collapses. Setup: Scenario 2 You are eating dinner at a wedding, when you hear a gasp coming from the table behind yours. You look over and notice a man lying on the ground. Prompter/ Responder Responder Prompter Responder Prompter Responder Action Checks the scene for safety Says, The scene is safe. Taps the persons shoulder and shouts, Are you okay? Says, There is no response. Directs someone to call 9-1-1 or the local emergency number Opens airway Quickly checks for breathing Quickly scans for severe bleeding Prompter Responder Says, There is no breathing. Gives 30 chest compressions Gives 2 rescue breaths Pushes down on the center of the manikins chest 30 times Places CPR breathing barrier on manikin, tilts head, lifts chin, pinches nose shut and blows into manikins mouth Points; speaks out loud Tilts head and lifts chin Ear is above manikins mouth; looks toward manikins chest Looks over manikins body Physically touches the manikin; speaks out loud What to Look For Pauses and looks at the scene before responding
Prompter
Says, The chest clearly rises.
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ADULT CPR SCENARIOS 1 AND 2 Continued
Prompter/ Responder Responder Action Gives 30 chest compressions What to Look For Removes or folds back CPR breathing barrier; pushes down on the center of the manikins chest 30 times Places CPR breathing barrier on manikin, tilts head, lifts chin, pinches nose shut and blows into manikins mouth
Gives 2 rescue breaths
Prompter Responder
Says, The chest clearly rises. Gives 30 chest compressions Removes or folds back CPR breathing barrier; pushes down on the center of the manikins chest 30 times Places CPR breathing barrier on manikin, tilts head, lifts chin, pinches nose shut and blows into manikins mouth
Prompter Responder
Says, The person begins breathing. Opens airway and monitors breathing Tilts head and lifts chin; monitors person
CHILD CPR SCENARIOS 1 AND 2

Setup: Scenario 1 You are with a friend playing Frisbee at a park. You hear some commotion near the playground. You run over and see a 10-year-old boy lying motionless on the ground. Prompter/ Responder Responder Prompter Responder Prompter Responder Prompter Responder Action Checks the scene for safety Says, The scene is safe. Obtains consent Says, The parent or guardian gives you consent. Taps the childs shoulder and shouts, Are you okay? Says, There is no response. Directs someone to call 9-1-1 or the local emergency number Opens airway Quickly checks for breathing Prompter Responder Says, There is no breathing. Gives 2 rescue breaths Places CPR breathing barrier on manikin; tilts head, lifts chin, pinches nose shut and blows into manikins mouth Points; speaks out loud Tilts head and lifts chin Ear is above manikins mouth; looks toward manikins chest Physically touches the manikin; speaks out loud Identifies him- or herself as CPR-trained; asks to help What to Look For Pauses and looks at the scene before responding
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CHILD CPR SCENARIOS 1 AND 2 Continued
Prompter/ Responder Prompter Responder Action Says, The chest clearly rises. Gives 30 chest compressions Removes or folds back CPR breathing barrier; pushes down on the center of the manikins chest 30 times Places CPR breathing barrier on manikin, tilts head, lifts chin, pinches nose shut and blows into manikins mouth What to Look For
Prompter Responder
Prompter Responder
Prompter Responder
Says, The child begins breathing. Opens airway and monitors breathing Tilts head and lifts chin; monitors child
Setup: Scenario 2 While walking your dog, you notice a group of children playing baseball. You see one of the children get struck with the baseball and then collapse to the ground. You tie your dog up and approach the scene. Prompter/ Responder Responder Prompter Responder Prompter Responder Prompter Responder Action Checks the scene for safety Says, The scene is safe. Obtains consent Says, The parent or guardian gives you consent. Taps the childs shoulder and shouts, Are you okay? Says, There is no response. Directs someone to call 9-1-1 or the local emergency number Opens airway Quickly checks for breathing. Quickly scans for severe bleeding Points; speaks out loud Tilts head and lifts chin Ear is above manikins mouth; looks toward manikins chest Looks over manikins body Physically touches the manikin; speaks out loud Identifies him- or herself as CPR-trained; asks to help What to Look For Pauses and looks at the scene before responding
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CHILD CPR SCENARIOS 1 AND 2 Continued
Prompter/ Responder Prompter Responder Action Says, There is no breathing. Gives 30 chest compressions Gives 2 rescue breaths Pushes down on the center of the manikins chest 30 times Places CPR breathing barrier on manikin, tilts head, lifts chin, pinches nose shut and blows into manikins mouth What to Look For
Prompter Responder
Prompter Responder
Prompter Responder
Says, The child begins breathing. Opens airway and monitors breathing Tilts head and lifts chin; monitors child
INFANT CPR SCENARIOS 1 AND 2

Setup: Scenario 1 At a family party, you and the other adults are sitting around the coffee table talking about your sisters 6-month-old daughter, who is nearby in a play pen. Your uncle tells a joke and everyone starts laughing. You look over to the play pen and notice that the infant is motionless. Setup: Scenario 2 A new mom is at the park with her 10-month-old infant. She reaches down to put away a toy in her bag. Afterward, she notices that the infant is motionless. She screams for help and you come over. Prompter/ Responder Responder Prompter Responder Prompter Responder Action Checks the scene for safety Says, The scene is safe. Obtains consent Says, The parent or guardian gives you consent. Flicks the infants foot or taps the infants shoulder and shouts, Are you okay? Physically touches the manikin; speaks out loud Identifies him- or herself as CPR-trained; asks to help What to Look For Pauses and looks at the scene before responding
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INFANT CPR SCENARIOS 1 AND 2 Continued
Prompter/ Responder Prompter Responder Action Says, There is no response. Directs someone to call 9-1-1 or the local emergency number Opens airway Quickly checks for breathing Prompter Responder Says, There are no signs of breathing. Gives 2 rescue breaths Places CPR breathing barrier on manikin; makes a seal over the mouth and nose and blows into manikin Points; speaks out loud Tilts head and lifts chin Ear is above manikins mouth; looks toward manikins chest What to Look For
Prompter Responder
Says, The chest clearly rises. Gives 30 chest compressions Removes or folds back CPR breathing barrier; pushes down on the lower half of the manikins chest with the pads of two or three fingers 30 times Replaces CPR breathing barrier; tilts head, lifts chin, makes a seal over the mouth and nose and blows into manikin
Prompter Responder
Prompter Responder
Prompter Responder
Says, The infant begins breathing. Opens airway and monitors breathing Tilts head and lifts chin; monitors infant
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AED SCENARIOS 1 AND 2
Setup: Scenario 1 You and a co-worker are eating lunch in the cafeteria when you notice a man (or a child) suddenly collapse. You follow the emergency actions steps CHECKCALLCARE. You instruct your co-worker to call 9-1-1 or the local emergency number and to get the AED from the break room while you begin CPR. When your co-worker returns with the AED, you are actively performing CPR. You are both trained in CPR/AED. Setup: Scenario 2 You are working at a clothing store in a busy shopping mall. You notice that several people are standing around an adult who has collapsed. You and a co-worker approach to investigate. You follow the emergency actions steps CHECKCALLCARE. You instruct your co-worker to call 9-1-1 or the local emergency number and to get the AED from the food court while you begin CPR. When your co-worker returns with the AED, you are actively performing CPR. You are both trained in CPR/AED. Prompter/ Responder Responder 1 Prompter Responder 1 Prompter Responder 1 Action Checks the scene for safety Says, The scene is safe. Taps the persons shoulder and shouts, Are you okay? Says, There is no response. Directs responder 2 to call 9-1-1 or the local emergency number and get the AED. Opens airway Quickly checks for breathing Quickly scans for severe bleeding Prompter Responder 1 Says, There is no breathing. Gives 30 chest compressions Gives 2 rescue breaths Pushes down on the center of the manikins chest 30 times Places CPR breathing barrier on manikin; tilts head, lifts chin, pinches nose shut and blows into manikins mouth Points; speaks out loud Tilts head and lifts chin Ear is above manikins mouth; looks toward manikins chest Looks over manikins body Physically touches the manikin; speaks out loud What to Look For Pauses and looks at the scene before responding
Prompter Responder 1 Prompter Responder 2
Says, The chest clearly rises. Gives 30 chest compressions Says, Your co-worker arrives with the AED. Turns on AED Wipes chest dry Plugs in connector Makes sure no one is touching the person Turns on AED Simulates wiping the chest dry Plugs connector into device Says, Everyone stand clear. Pushes down on the center of the manikins chest 30 times
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AED SCENARIOS 1 AND 2 Continued
Prompter/ Responder Responder 1 Action Continues compressions What to Look For Pushes down on the center of the manikins chest until responder 2 says, Everyone stand clear.
Says, Everyone is clear. Pushes analyze button and lets AED analyze heart rhythm Says (or device says), Shock advised. Makes sure that no one is touching the person Pushes shock button Says, Everyone stand clear. Pushes shock button Pushes analyze button and stays clear of the person and the AED
Says (or device says), Shock delivered. Continues CPR Says, The person begins breathing. Opens airway and monitors breathing Tilts head and lifts chin; monitors person Resumes cycles of 30 chest compressions and 2 rescue breaths as quickly as possible
FIRST AID SCENARIOS 1 AND 2

Setup: Scenario 1 You are talking with a man while waiting in line at the department of motor vehicles. The man drops his wallet, which he was holding with his left hand. He mumbles something but you cannot make out what he says. He leaves his wallet on the ground and sits down on one of the waiting room chairs. It appears that something is wrong. Prompter/ Responder Responder Prompter Responder Prompter Responder Action Checks the scene for safety Says, The scene is safe. Obtains consent Identifies him- or herself as first aid-trained; asks to help What to Look For Pauses and looks at scene before responding
Says, The person tries to respond, but you cannot understand what he says because he is mumbling. Asks the person to smile Recognition that the person could be having a stroke (FAST); looks for signs of weakness on one side of the face
Prompter Responder Prompter Responder
Says, The person is unable to smile with the left side of his mouth. Asks the person to raise both arms (palm side up) Looks for signs of weakness on one side of the body
Says, The person raises both arms but has trouble lifting the left arm. Asks the person to speak a simple sentence Looks for signs of slurred speech or trouble getting the words out
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FIRST AID SCENARIOS 1 AND 2 Continued
Prompter/ Responder Prompter Responder Action Says, The persons speech is slurred. Directs someone to call 9-1-1 or the local emergency number Notes the time signals were first observed Monitors the persons breathing and looks for any changes in condition Prompter Points; speaks out loud Indicates that he or she would note the time signals were first observed Monitors breathing and looks for any changes in condition What to Look For
Says, Advanced medical personnel have arrived and are now taking over.
Setup: Scenario 2 You are sitting on a city bus when you notice a person slumped over in her seat, sweating and staring blankly ahead. The person sitting next to her says, Somebody help, something is wrong. Prompter/ Responder Responder Prompter Responder Prompter Responder Prompter Responder Prompter Responder Prompter Responder Prompter Responder Prompter Responder Prompter Responder Action Checks the scene for safety Says, The scene is safe. Obtains consent Says, The person gives you consent. Asks the person, What is your name? Says, The person gives you her name. Asks the person, What happened? Says, She does not know. Asks the person, Do you feel pain or discomfort? If so, where? Says, The person has a bad headache. Asks the person, Do you have any medical conditions? Says, The person has diabetes. Asks the person, Are you taking any medications? Asks simple questions to learn about what happened Asks simple questions to learn about what happened Asks simple questions to learn about what happened Asks simple questions to learn about what happened Asks simple questions to learn about what happened Identifies him- or herself as first aid-trained; asks to help What to Look For Pauses and looks at scene before responding
Says, The person takes prescription medication for diabetes. Asks the person, When did you last eat or drink anything? Asks simple questions to learn about what happened
Says, The person has not had anything to eat today and drank only water all day. Gives the person some form of sugar Has the person rest in a comfortable position Looks/asks for some form of sugar Helps the person rest in a comfortable position; continues to monitor the persons reaction to the sugar
Prompter
Says, No additional care is needed at this moment.
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Scenario Worksheets
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HEALTH PRECAUTIONS AND GUIDELINES DURING TRAINING

The American Red Cross has trained millions of people in first aid, CPR, and AED using manikins as training aids. The Red Cross follows widely accepted guidelines for cleaning and decontaminating training manikins. If these guidelines are adhered to, the risk of any kind of disease transmission during training is extremely low. To help minimize the risk of disease transmission, you should follow some basic health precautions and guidelines while participating in training. You should take additional precautions if you have a condition that would increase your risk or other participants risk of exposure to infections. Request a separate training manikin if you:

Have had a positive blood test for hepatitis C virus. Have a type of condition that makes you extremely likely to get an infection.
To obtain information about testing for individual health status, go to the Centers for Disease Control and Prevention website (cdc.gov). After a person has had an acute hepatitis B infection, he or she will no longer test positive for HBsAg but will test positive for the hepatitis B antibody (anti-HBs). People who have been vaccinated against hepatitis B will also test positive for anti-HBs. A positive test for anti-HBs should not be confused with a positive test for HBsAg. If you decide that you should have your own manikin, ask your instructor if he or she can provide one for you. You will not be asked to explain why you make this request. The manikin will not be used by anyone else until it has been cleaned according to the recommended end-of-class decontamination procedures. Because the number of manikins available for class use is limited, the more advance notice you give, the more likely it is that you can be provided a separate manikin. *People with hepatitis B infection will test positive for HBsAg. Most people infected with hepatitis B virus will get better in time. However, some hepatitis B infections will become chronic and linger for much longer. People with these chronic infections will continue to test positive for HBsAg. Their decision to participate in CPR training should be guided by their physician.
Have an acute condition, such as a cold, sore throat or cuts or sores on your hands or around your mouth. Know that you are seropositive (have had a positive blood test) for hepatitis B surface antigen (HBsAg), which indicates that you are currently infected with the hepatitis B virus.* Know that you have a chronic infection as indicated by long-term seropositivity (long-term positive blood tests) for HBsAg* or a positive blood test for anti-HIV, that is, a positive test for antibodies to human immunodeficiency virus (HIV), the virus that causes many severe infections, including acquired immunodeficiency syndrome (AIDS).
Guidelines
In addition to taking the precautions regarding manikins, you can protect yourself and other participants from infection by following these guidelines:

Wash your hands thoroughly before participating in class activities. Do not eat, drink, use tobacco products or chew gum during class when manikins are used. Clean the manikin properly before use. For some manikins, cleaning properly means vigorously wiping the manikins face and the inside of its mouth with a clean gauze pad soaked with
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either a fresh solution of liquid chlorine bleach and water ( cup of sodium hypochlorite per gallon of tap water) or rubbing alcohol. The surfaces should remain wet for at least 1 minute before they are wiped dry with a second piece of clean, absorbent material. For other manikins, cleaning properly means changing the manikins face. Your instructor will provide you with instructions for cleaning the type of manikin used in your class. Follow the guidelines provided by your instructor when practicing skills such as clearing a blocked airway with your finger.
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Physical Stress and Injury

Successful course completion requires full participation in classroom and skill sessions, as well as successful performance during skill and knowledge evaluations. Because of the nature of the skills in this course, you will participate in strenuous activities, such as performing CPR on the floor. If you have a medical condition or disability that will prevent you from taking part in the skill practice sessions, please tell your instructor so that accommodations can be made. If you are unable to participate fully in the course, you may audit the course and participate as much as you can or desire but you will not be evaluated. To participate in the course in this way, you must tell the instructor before training begins. Be aware that you will not be eligible to receive a course completion certificate.
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Health Precautions and Guidelines During Training
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MASTER CHECKLIST OF COURSE MATERIALS, EQUIPMENT AND SUPPLIES

The following is a list of the materials, equipment and supplies necessary to teach American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED course:
For the Class
Equipment for viewing video segments: American Red Cross Responding to Emergencies: Comprehensive First Aid/ CPR/AED DVD. The video segments can also be viewed on Instructors Corner. DVD player, monitor Power source Extension cord and grounded plug adaptor, if needed OR Responding to Emergencies course presentation: System requirements: Adobe Reader 9 Flash Player 8 or 9 for Windows and Mac Laptop/desktop computer Power source Extension cord and grounded plug adaptor, if needed Projector (including any connection cables) Projection screen/area Computer speakers (or other source for sound)
Extra manikin lungs, airways and faces Blankets or mats (one for every two participants) AED training devices (one for every two participants) Adult AED training pads (one set per training device) Pediatric AED training pads (one set per training device) External bleeding control materials for every two participants: Two 3-inch roller bandages Four 4" 4" nonsterile dressings or gauze pads
Extra printed copies of American Red Cross Adult Ready Reference Card and/or American Red Cross Pediatric Ready Reference Card (optional) Checking an Injured or Ill Adult, Child or Infant skill poster (Stock No. 656734) (optional) CPR skill poster (Stock No. 656737) (optional) Applying a Splint skill poster (Stock No. 656729) (optional) Splinting materials for optional splinting skill session (for each pair of participants): Four triangular bandages One 3-inch roller bandage Blanket or pillow Rigid splints (magazines, cardboard, long and short boards or commercial splints)
Manikin decontamination supplies (decontaminating solution, 4" 4" gauze pads, soap and water, brush, basins or buckets, nonlatex disposable gloves and any accessories that may be recommended by the manufacturer of the manikin) Newsprint and markers, easel or tape Adult manikins (one for every two participants) Child manikins (one for every two participants) (optional) Infant manikins (one for every two participants)
Note: American Red Cross Student Training Kits for CPR and/or First Aid may be used to substitute for some items on this list.
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For Participants

Name tags Pencils and/or pens CPR breathing barriers Nonlatex disposable gloves (multiple sizes) American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED textbook (e-book, print out or hard copy)
Final written exams (Appendix I) Answer sheet for written exams (Appendix I)
Note: American Red Cross Student Training Kits for CPR and/or First Aid may be used to substitute for some items on this list.
For the Instructor

American Red Cross identification Name tag American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED Instructors Manual or printed copy of lesson plans Participant course evaluation forms (Instructors Corner) Course Record and Course Record Addendum (Instructors Corner)
Participant progress log (Appendix E and Instructors Corner) Extra pens or pencils American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED textbook (e-book, print out or hard copy) (optional) Answer keys for written exams (Appendix I)
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Master Checklist of Course Materials, Equipment and Supplies
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TEACHING STRATEGIES
Teaching the Lessons
Before you teach a lesson, you should read the lesson plan, review the appropriate pages in the participants textbook and gather necessary materials, equipment and supplies. Each lesson plan contains the following:

Facilitating Discussion
Many activities and discussions in this course make use of facilitation principles, with the course instructor serving as the facilitator. Facilitation is based on the concept of pushing, pulling and balancing the flow of information. Push skills have to do with information flowing mostly from instructor to participants. Pull skills are used when the instructor engages participants through the use of interactive exercises and by asking and answering questions or using other approaches that actively involve participants in their own learning, such as with the use of open-ended questions. Balance skills involve managing the push and pull of information to keep the learning process moving and to maximize learning. When you facilitate classroom discussion and participant responses, keep in mind the following points:

Lesson name Lesson objectives (specific course knowledge and skill objectives appropriate to the lesson) Guidance for the instructor (steps to be taken to complete the lesson) Materials, equipment and supplies (materials specific to course being taught) Topic names Activities (class exercises that enhance participants understanding of the course material) Skill sessions (practice of skills by participants; not all lessons contain skill sessions) Visual aids (the visual instructional aids that can be used) Lesson wrap-up (lesson review)
Maximize class interaction. Use pull skills to engage participants in classroom discussions and keep discussions on topic, or provide necessary information. Pull skills are also useful for soliciting responses from different participants to prevent one participant from dominating the discussion. Promote an open exchange of information and ideas by asking open-ended questions (i.e., questions that begin with who, what, when, where, why or how), waiting for responses, listening, managing silence and referring participants questions back to the group for discussion and resolution. Ensure effective discussion sessions by giving and receiving feedback, maintaining an open perspective, setting the climate, staying on topic and managing time effectively.
There are multiple teaching strategies used throughout the course to keep participants engaged, including activities and skill sessions. Rather than simply lecturing to participants, maximize learning by facilitating class discussion and interaction. Question and answer sessions are built into the course to help such interaction. The questions enable participants to think about the issues and draw on experience or prior knowledge.
Working with Your Audience

Understanding your audience will help you engage participants in course activities. If you can relate to your audience, you will be better able to facilitate the activities successfully, help participants associate classroom information with personal experiences, provide a positive learning environment and maintain participants self-esteem. You may have adults and youths from a variety of age groups in your course. Being aware of these differences before the course begins can help you anticipate any issues before they arise, such as different levels of understanding and skill.
Facilitation techniques allow you to evaluate participants knowledge and understanding throughout the course. In addition, facilitation:
Gives you the opportunity to evaluate the groups needs and focus the activities on those needs.
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Allows you to build on participants previous knowledge and skills. Allows participants to associate previous knowledge and skills with new information.
Allows participants to learn from one another. Keeps participants engaged and interested throughout the course.
Activities
The educational activities in this course:
Are learner-focused and involve ongoing evaluation of participants, beginning when they enter the classroom. Teach participants to use their critical-thinking skills to solve problems. Allow participants to associate information with their personal experience.
to write bullet points on newsprint before the class to facilitate the learning process. This practice also helps you meet the participants various learning needs. When delivering a lecture, it is important that the lecture be dynamic and engaging. By keeping the lecture moving, avoiding long stories of personal experiences and maintaining a learner-centered focus, you will vastly improve educational outcomes. One way to accomplish this is to prepare for interactive lectures. An interactive lecture will have opportunities for two-way communication between participants and the instructor as well as among the participants themselves. To prepare an interactive lecture, keep the following suggestions in mind:

Guided Discussion
The instructors role in the guided discussions is critical. The ability to introduce questions that prompt discussion is an important aspect of facilitating good discussions. The purposes of asking questions for guided discussions are to:
Ensure that you understand the purpose of the lecture and plan accordingly. Feel free to rephrase the lecture points to fit your natural speaking style. Prepare lecture notes so that you can avoid reading from the instructors manual while lecturing. Use analogies to help create a bridge between lecture material and participants experiences. Strive for interaction with participants during lectures. Encourage participants to add to the lecture.
Increase comprehension (i.e., when the group does not understand something, the discussion may offer an alternative explanation that clarifies the information for participants). Monitor and evaluate the groups level of understanding. Focus the groups attention on the relevant topic. Ensure that the group covers all of the supplied content for each activity.
Lectures
Instructor presentation, or lecture, is sometimes the most effective way to deliver information. However, because lecturing is a passive way for participants to learn, it should be kept as brief as possible. Too much lecturing causes participants to become disengaged, thereby resulting in less effective learning. Lecture points are specific content that instructors must communicate to participants and are written so that they can be read aloud as written or rephrased as needed. When you use lecture points, it is important that you fully understand the content in order to rephrase or provide context as needed. If you are using the course presentation, the main points for the lecture are included on the accompanying slide. If you are not using the course presentation, it is often helpful
Group Activities
This course also uses group exercises to meet learning needs and promote interaction. When conducting group exercises, you should choose both the size and makeup of the groups. Form groups using the fewest number of participants necessary to conduct the exercise. Keeping the group size small will help prevent potential group-dynamics issues and establish a comfortable environment for the exchange of ideas. Form new groups for each activity. Changing group members among activities promotes class cohesion, prevents situations in which one or more participants feel left out and keeps friendships from taking precedence over learning. Using an arbitrary selection criterion each time you form groups will help you vary
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group makeup and give participants the chance to interact with different classmates. For example, ask participants one of the following: Find the person in class whose birthday is closest to yours and form a pair; find the person who lives the farthest from you and form a pair; or find the other people in class whose birthday is in the same season as yours (winter, spring, summer or fall) and form a group.
Lesson Wrap-Ups
These question-and-answer sessions are found at the end of each lesson. As you lead the wrap-ups, ask for volunteers to provide answers. Waiting up to 10 seconds for an answer can help encourage hesitant participants to answer. Call on participants by name if you are having a hard time finding volunteers. However, do not insist that all participants provide answers. Participants can still gain from this format even if they appear reluctant to answer. Ideal responses are provided for each question. Answers labeled, Responses could include, are examples of one or more possible correct answers. For these questions, an example of a correct answer is provided in case participants are unable to come up with the correct answer(s) on their own. Answers labeled, Responses should include, are the correct answer(s) that must be covered. In this case, instructors must provide any or all of the answers if participants are unable to come up with the correct answer(s) on their own.
Small-Group Exercises
Small-group exercises use two to four participants working together to either solve a problem or complete an activity. These exercises allow participants to use one anothers knowledge to solve problems and learn from others experiences.
Large-Group Exercises
Large-group exercises use large numbers of participants or the whole class to solve a problem or complete an activity. When the entire class works together, it provides an opportunity to exchange ideas, discuss problems and think about the many ways to solve a problem.
Conducting Skill Sessions

Skill sessions are a critical component of most American Red Cross courses that lead to certification. Skill sessions should be well organized and well managed. During the skill sessions, participants are learning and perfecting skills. These sessions should include direction and instruction, ample practice time, instructor reinforcement, corrective feedback and encouragement to ensure participants success. Plan the skill sessions to reinforce learning objectives. Skill session structure may include practice while participants watch, when they practice the skill along with on-screen instruction; watch then practice, when participants receive on-screen instruction and then apply that knowledge by practicing the skill; and practice then watch, when participants explore and create knowledge by attempting a skill and then view on-screen instruction to confirm skill competence. When conducting a course that includes adult and child skills, you may conduct either the adult or the child skill sessions, based on the needs of the participants. The video segments and class instruction for these skills contain all the necessary information for both skills. However, if your course includes infant skills in combination with adult and/or child skills, you
must conduct the infant skill sessions. For courses that include only infant skills, the full infant video segments must be viewed. During the skill sessions, you are responsible for:

Maintaining a safe learning environment. Ensuring that participants can see the video monitor when appropriate. Helping participants form pairs and making sure that they have the necessary equipment for skill practice (e.g., CPR breathing barriers, nonlatex disposable gloves). Demonstrating a skill or skill components and/or guiding participants through a skill. Keeping the sessions running smoothly. Providing sufficient time for all participants to practice each skill. Identifying errors promptly and providing appropriate feedback to help participants improve their skills. Encouraging participants to improve their skills. Checking each participant for skill competency.
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Orienting Participants to Skill Sessions
Orienting participants to the skill sessions will help them get started quickly and practice more efficiently. Participants should practice in groups of two or three. Some skill sessions require participants to practice on a partner, whereas others require practice on a manikin. Practice on a real person (partner) is important because participants gain experience giving care to someone and understanding how care is experienced. a chance to practice the skill. During partner practice, be sure that participants do not engage in horseplay, which can lead to injury. To ensure a satisfactory comfort level, it is better to allow participants to choose their partners. Some participants may be reluctant to practice with participants of the opposite sex. Instructors should accommodate participants preferences. It is important that partner pairs be rotated (exchange roles), otherwise one partner will gain most of the skills while the other partner misses a critical learning experience.
Coaching vs. Prompting Participants

The desired outcome of each skill session is for participants to demonstrate a skill correctly from beginning to end without receiving any assistance from you or a partner, or referring to the participant materials. Because participants learn at different rates, bring different levels of knowledge and learn in different ways, you will find yourself generally coaching or guiding participants as they first learn skill elements. Coaching occurs in the initial phases of skill practice and allows you to give participants information that they need to establish a sequence, timing, duration and technique of a particular skill. When coaching, which is also known as guided practice, provide information such as the sequence of steps in a skill. Statements such as, Check the scene for safety or Check the person for consciousness, are examples of coaching. Once guided practice ends and independent demonstration of a skill begins, you should change tactics and shift to prompting. Prompting allows instructors to assess that a participant is able to make the right decision at the right time and give the appropriate care. The putting-it-all-together portions of the video segments are designed for prompt-only practice. Because participants are expected to demonstrate skills without any assistance, when you prompt someone, provide only the information necessary for the participant to make a decision and give care. In other words, you should give information only about the conditions found. For example, say, The child is unconscious instead of Call 9-1-1, or Breaths do not go in instead of Give a rescue breath.
Instructor-Led Practice
Instructor-led practice can be used to focus on a skill or part of a skill. It is particularly useful for introducing new skills that build on previously learned skills or for safety reasons. With this method, the instructor guides participants through each step of a skill while checking on participants to ensure that everyone in the group completes the steps properly as the instructor calls them out. When you lead the practice, position yourself so that you can see everyone. It may help to have participants heads pointing in the same direction and their partners in the same relative position next to them. Being able to see everyone allows you to monitor skill performance as well as ensure participant safety.
Reciprocal Practice
Reciprocal practice occurs when course participants guide, provide feedback and check one anothers skill performance. The goal is for a participant to demonstrate a skill correctly without any assistance from a partner. During reciprocal practice, move among participants and observe them to ensure that they are appropriately practicing the skills and are receiving feedback from their partners. Provide feedback as appropriate and offer assistance as needed. Remember, if you can observe a participant correctly demonstrate a skill from start to finish without assistance and at the level of proficiency indicated on the skill assessment tool, you may check off that persons skill on the participant progress log. Let the participant know that no further demonstration of that skill is required.
Partner Practice
Practicing on a partner has been included in this training to provide participants with experience giving care to a real person. One participant acts as the injured or ill person while the other gives care. Participants change roles so that each participant has
How Participants Learn Skills

Closely supervise participants during skill sessions. The time for learning and refining skills in this course is relatively short. Therefore, skill sessions, particularly
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the first one, are demanding of the instructors. By carefully planning the first session and commending participants for practicing correctly, you can create a positive learning environment. The skills taught will likely be new to most participants and may require frequent one-on-one attention. Keeping in mind the following list of skill characteristics will allow for more effective skill sessions.

are practicing incorrectly, provide specific corrective feedback. Before saying what they are doing wrong, tell them what they are doing correctly. Then, tactfully help them improve their performance. Other strategies for corrective feedback include the following:
Course skills are complex. Participants often have some difficulties when they first begin. Skills are learned by hands-on practice. Immediate success in demonstrating the skill is unlikely. Refinements in technique take time and practice. Allow participants multiple opportunities to practice skills. Skills require a defined sequence of movements. Participants should consistently follow this sequence when learning skills. Learning times for each skill differ, because some skills are easier than others. Participants have different learning rates. Take individual differences into account when teaching any course. Skills, especially the individual components of opening the airway and checking for breathing, are quickly forgotten. Frequent practice improves skill retention.
If the error is simple, explain directly and positively how to correct the skill performance. Be specific when providing feedback. For example, if the participant is having trouble finding the proper hand placement for CPR, you might say, The steps leading up to beginning CPR are good; now, try finding the center of the chest for compressions. That will be the spot you want to aim for. Show the participant what he or she should be doing. For the previous example, you might have to demonstrate hand placement for the person doing the skill. Explaining why participants should perform a skill in a certain way may help them remember how to perform the skill correctly. For example, if a participant continually forgets to check a scene for safety before assessing a patient, you might remind the participant that the responder can quickly become injured or ill because of an unsafe scene. If a participant has an ongoing problem with a technique, carefully observe what he or she is doing. Give specific instructions for performing the technique the correct way and lead the participant through the skill. It may help to have the participant state the steps back to you for reinforcement. Emphasize the critical performance steps to focus on those skills that make a difference in the successful completion of a skill. During skill sessions, resist telling participants anecdotes, which can distract or confuse participants. Remind participants what they are doing right and what they need to improve. Use phrases such as, Your arms are lined up well, but try to keep them as straight as possible while giving compressions to help ensure that they are effective. Help participants focus on the critical components of each skill.
Helping Participants Practice Correctly

Practicing a skill aids learning only when the skill is performed correctly. One of your most difficult challenges as an instructor is to ensure that participants practice correctly. Continually monitor all participants, watching for errors participants make while they are practicing. Try to correct problems as soon as possible so that participants will practice the skill correctly. While you are working closely with one participant, check others with an occasional glance. Correct any problems you notice to keep participants from continuing to practice incorrectly. Encourage participants to ask questions if they are unsure how to perform any part of a skill. A positive learning environment is important. Participants perform best when you keep them informed of their progress. When participants are practicing correctly, provide positive feedback that identifies what they are doing correctly. If participants
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Participants with Disabilities and Other Health Considerations

People with disabilities and other health conditions can perform the skills in the Responding to Emergencies program. In some cases, the skills needed to care for injured or ill individuals may need modification, but the result is the same. Instructors should focus on the critical components of a skill that are needed to successfully meet the objective. Instructors must always teach to the standards set forth but must be aware that participants may modify how a skill is accomplished and still meet the objective, which allows them to receive certification in the course. See the Americans with Disabilities Act (ADA) Accommodation Resource Guide for Conducting And Administering Health And Safety Services Courses on Instructors Corner for more information. As a Red Cross instructor, you may conduct a course that includes a person with a disability or other condition. Participants with a physical disability include those who are deaf or hard of hearing, legally blind, lack full use of limbs, have breathing difficulties, or have other physical problems. When a participant with a disability or other condition can successfully meet course objectives, he or she should receive a course completion certificate. If a participant cannot meet the course objectives because of a disability or other condition, this should be communicated to the participant as early as possible.
Helping Participants with Physical Disabilities

To help a participant who has a physical disability, you may modify the delivery of course materials as follows:

Increase the amount of time you spend with each participant Allow frequent rest periods Help participants modify the techniques necessary for successful skill completion
People with Reading Difculties and Disabilities

If you believe that a class includes participants who have reading difficulties or disabilities, you should discuss this with those participants individually and privately without attracting the attention of the rest of the class. You should make modifications that will allow these individuals to participate fully in class, such as reading any necessary material to the class. Problems with reading skills may be present when:

A participant does not follow along with written material or turn pages as the instructor reads. A participant says that he or she: Forgot his or her glasses. Has not done well in educational settings. Does not do well in testing situations.
Identifying People with Reading Difculties or Disabilities

Course participants will do some reading during this course. You must be prepared to detect any such difficulties and provide those participants with every opportunity to succeed, including modifications. Some participants may have difficulty reading because English is his or her second language. Through observation, you may be able to detect that an individual has reading difficulties.
Helping Participants with Reading Difculties or Disabilities

Final written exams are a required component of the course. If you determine your participant may have reading difficulties, you may administer an oral exam instead.
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PARTICIPANT PROGRESS LOG
Removing Gloves Checking an Injured or Ill Adult (Appears to be Unconscious) Checking an Injured or Ill Child or Infant (Appears to be Unconscious) CPRAdult (No Breathing) CPRChild (No Breathing) CPRInfant (No Breathing) AEDAdult AED Skill Practice and Scenarios Adult or Child Older than 8 Years or Weighing More than 55 Pounds AEDChild and Infant Younger than 8 Years or Weighing Less than 55 Pounds AED Skill Practice and Scenarios Child and Infant Younger than 8 Years or Weighing Less than 55 Pounds Assisting with an Asthma Inhaler Conscious ChokingAdult and Child (Cannot Cough, Speak or Breathe) Conscious ChokingInfant (Cannot Cough, Cry or Breathe) Unconscious ChokingAdult (Chest Does Not Rise with Rescue Breaths) Unconscious ChokingChild (Chest Does Not Rise with Rescue Breaths) Unconscious ChokingInfant (Chest Does Not Rise with Rescue Breaths)
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Controlling External Bleeding Using a Manufactured Tourniquet Applying an Anatomic Splint Applying a Soft Splint Applying a Rigid Splint Applying a Sling and Binder Assisting with an Epinephrine Auto-Injector Final Written Exam I: Before Giving Care Final Written Exam II: CPR/AED Final Written Exam III: Responding to Emergencies: First Aid
Skills shaded in gray are considered optional.
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AED RESOURCE INFORMATION

The following information is provided as a resource for instructors and instructor trainers who conduct the lesson containing automated external defibrillation (AED) information. It is not intended for this information to be added to all the current American Red Cross AED training courses. Significant guidance, review and input was provided by the American Red Cross Scientific Advisory Council (SAC) chair and subject-matter expert David Markenson, MD, FAAP, EMT-P.
Introduction
Each year, more than 300,000 people die of sudden cardiac arrest in the United States. Sudden cardiac arrest in adults is most commonly caused by an abnormal heart rhythm called ventricular brillation (V-fib). This cardiac arrhythmia is characterized by completely disorganized electrical activity, which causes the heart to quiver and cease functioning as a pump. While less common, ventricular tachycardia (V-tach) can also cause sudden cardiac arrest. V-tach occurs when there is very rapid contraction of the ventricles. It is so rapid that the heart is no longer able to pump blood. Sudden cardiac arrest can happen to anyone at any timeand not just to adults. Debrillation is an electrical shock that can correct V-fib and V-tach by interrupting the chaotic electrical activity and helping the heart to re-establish an effective electrical rhythm. An AED is a portable electronic device that analyzes the hearts rhythm and, if necessary, tells the responder to deliver a shock to a person of sudden cardiac arrest. Care for persons of sudden cardiac arrest has been greatly improved through the advent of more widespread and rapid access to AEDs. These devices allow for quick detection and defibrillation of a shockable rhythm by trained, nonprofessional responders and even the lay public. This technological breakthrough has led to increased detection and treatment of V-fib and V-tach in persons of all ages.
Causes of Cardiac Arrest in Adults

Causes of cardiac arrest in adults include:

Airway obstruction. Brain damage. Electrocution. Trauma.
Cardiovascular disease. Abnormal electrical activity of the heart (arrhythmias). Drowning.
Debrillation Recommendations for Pediatric Victims

While it is not known exactly how many pediatric incidents occur, studies suggest that there may be more occurrences of V-fib than previously believed. Recent studies have also shown that the chance for survival is much higher for V-fib than other abnormal rhythms. Traditional therapy for children has not included early rhythm detection and possible defibrillation, and these studies have shown that this may represent missed opportunities to save a childs life. Unfortunately, there is a shortened window of opportunity for detection of V-fib in children when compared to adults and, as such, a small window of opportunity for subsequent rapid defibrillation. This window of opportunity may be lost for a lack
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of early recognition of V-fib because of the initial emphasis placed on airway and breathing problems at the exclusion of all else by traditional emergency care procedures. Early detection of V-fib in children and infants is critical to ensure the best chance of survival for a child in cardiac arrest with a shockable rhythm. Even though studies began suggesting that this window of opportunity to treat V-fib in children existed, there was a lack of equipment for rapid detection and early defibrillation. The development of special pediatric AED pads and equipment addresses concerns regarding the possibility of injury to young children and infants caused by the higher energy levels of conventional AEDs used for adults. AEDs that are configured for persons under age 8 or weighing less than 55 pounds have been proven reliable and accurate in determining shockable rhythms and delivering effective shocks. Further, this advance in defibrillation technology was reviewed and approved by the Food and Drug Administration (FDA). On July 1, 2003, the Pediatric Advanced Life Support (PALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) released updated guidance and an advisory statement that supported the use of pediatric AED pads on persons between the ages of 1 and 8 (and less than 55 pounds) who have no pulse and are not moving or breathing. Subsequent to this ILCOR advisory statement, the American Academy of Pediatrics (AAP) released new guidance. In the November 2007 issue of its official journal, Pediatrics, the AAP published a policy statement supporting the use of pediatric AED equipment on children and infants in cardiac arrest. This statement advises that an AED can be used on a child or an infant (under age 8 or weighing less than 55 pounds). AEDs equipped with pediatric defibrillation pads are capable of delivering lower levels of energy that are considered appropriate for children and infants up to 8 years old or weighing less than 55 pounds. Pediatric AED pads and/or equipment should be used, if available. However, if pediatric-specific equipment is not available, an AED designed for adults can be used on children and infants. In any event, local protocols, medical direction and the manufacturers instructions should always be followed. The Red Cross supports the consensus of the scientific community. While the incidence is relatively low compared to adults, cardiac arrest resulting from V-fib does happen to young children and infants and is no less dramatic. The emotional trauma and devastation of the loss of a child to a family and community cannot be measured.
Causes of Cardiac Arrest in Children and Infants

Most cases of cardiac arrest in children and infants are not sudden. Causes of cardiac arrest in young children and infants include:

Traumatic injuries or an accident (e.g., automobile accident, drowning, electrocution or poisoning). A hard blow to the chest (i.e., commotio cordis). Congenital heart disease. Sudden infant death syndrome (SIDS).
Airway problems. Breathing problems.
The Role of CPR

Quality CPR, especially if it is started promptly, can help by keeping blood containing oxygen flowing to the brain and other vital organs and may increase the chances of a successful defibrillation shock. However, in cases of sudden cardiac arrest, CPR by itself is insufficient to correct the hearts underlying electrical problem. AEDs are needed to correct the problem. Once CPR has been started, it should not be interrupted unnecessarily. After a shock is delivered or if no shock is advised, CPR is performed without interruption until the AED begins rhythm analysis or there is an obvious sign of life, such as when normal breathing returns or the person regains consciousness. As demonstrated in the Cardiac Chain of Survival, the sooner 9-1-1 or the local emergency number is called and CPR is initiated, and the quicker an AED can be applied and advanced medical care can be provided, the better the chance of survival.
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Debrillation

AEDs provide an electric shock to the heart called defibrillation. Delivering an electric shock with an AED disrupts abnormal electrical activity long enough to allow the heart to develop an effective rhythm on its own.
The sooner a shockable rhythm is identified and the defibrillation shock is administered, the greater the likelihood the person will survive. Defibrillation treats the specific abnormal rhythm, most commonly V-fib.
Debrillation Equipment Operation and Pad Placement

The manufacturers operating instructions and local protocols should always be followed. Pads are reversible. Reversal of pads may affect data display and analysis of rhythm but not the delivery of the defibrillation. However, always try to ensure correct pad placement. If the pads are not securely attached to the persons chest or if the cables are not fastened properly, the responder will receive a Connect electrodes or other error message from the AED. This message may appear in print on the small screen on the front of the machine or may be announced in a voice prompt. If you receive such a message, check to see that the pads and cables are attached properly. In all cases, the manufacturers instructions must be followed because AEDs differ in the type of cables and adhesive electrode pads used. At this point, the AED is ready to analyze the heart rhythm. Some devices require the responder to press a button marked analyze to have the machine examine the heart rhythm. Other models automatically analyze the heart rhythm. The responder must ensure that no one is touching or moving the person during this time. If the AED identifies a rhythm that should be defibrillated, it will prompt either with an on-screen message or by voice, or both. This message often states, Shock advised, followed by Press to shock or Press the shock button now, which indicates that the responder must press a button to defibrillate the person. A voice prompt from the AED will also advise everyone to Stand clear before administering a shock. This is an important measure that all present must follow. Any time an AED is analyzing the rhythm, charging to a specific energy level or delivering a shock, the responder
and others must not be in contact with the person. This will ensure that the rhythm analysis will be accurate and that no one other than the person will receive any of the electrical energy when it is discharged. It is the responsibility of the person who operates the AED to warn responders and bystanders to move away from contact with the person before analyzing and before pressing the shock button. This can be done by shouting, Stand clear! Another common warning is Im clear, youre clear, everybody clear! while actually checking around the person before pressing the shock button.
In some instances, the heart will not require defibrillation. In these cases, the AED device will inform you that no shock is needed. The AED should be left attached to the person and turned on. Unless there is an obvious sign of life (movement, normal breathing or pulse), immediately resume CPR.
Note: Some AEDs are fully automatic and do not require the operator to press a button to deliver a shock. When using this type of AED, extra care should be taken to ensure that no one is touching the person before the AED delivers a shock. Follow the manufacturers instructions and local protocols to use the unit correctly.
The number of shocks the AED delivers and the energy level for each shock are often preset by the manufacturer according to the standard of care established by the state or local emergency medical services (EMS) authority. The medical director of the individual or local AED program can establish local operating protocols based on the area EMS or regulatory guidelines. The 2010 Consensus on Science recommends a standard AED protocol of 1 shock immediately followed by about 2 minutes of CPR.
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Debrillation Equipment Operation and Pad Placement for Pediatric Victims
Currently, several of the devices available use technology that attenuates, or lowers, the energy level of the defibrillation shock. This may provide either one single-energy level shock or multiple shocks of single energy or escalating energy, but all will be at a lower energy level than would be delivered without the attenuation circuitry. The energy-lowering circuitry may be encased in a conspicuous plastic housing located between the pads connector on one end and the pads themselves on the other end. Some AEDs have a keyed adapter that is inserted into the AED for switching to pediatric operation.

If a trained responder is unsure and the child appears to be older than 8 years of age or to weigh more than 55 pounds, care should not be delayed to determine the exact age and weight. The adult AED pads and AED equipment should be applied and used. In some areas of the country, local protocols may allow the use of AEDs with nonpediatric AED pads for children and infants of all ages. This protocol will be based on the local medical directors estimate of the potential risk of use of these devices being far less than the benefit of defibrillating a child in V-fib. A responder should only use nonpediatric AEDs on children and infants under 8 years of age or less than 55 pounds if approved and allowed by local medical protocol and pediatric pads or adapters are not available. For a child or an infant in cardiac arrest, follow the same general steps and precautions that you would when using an AED on an adult. If the pads risk touching each other because of the smaller chest size, use the front/back (anterior/posterior) method of pad placement.
This visible feature and other visible markings unique to the pediatric pads lead to easier recognition of the pads as appropriate for pediatric persons (younger than age 8 or weighing less than 55 pounds) and are less likely to be confused with other defibrillation equipment. Pad placement is the same regardless of the make or model.
Special Resuscitation Situations

Some situations require responders to pay special attention when using an AED. It is important that responders be familiar with these situations and are able to respond appropriately.

Hypothermia. People with hypothermia have been resuscitated even after prolonged exposure. If there is no normal breathing, begin CPR until an AED becomes available. Dry the persons chest and attach the AED. If a shock is indicated, deliver a shock and follow the instructions of the AED. If there is still no normal breathing, continue CPR. Follow the local protocol as to whether additional shocks should be delivered. CPR should be continued and the person should be protected from further heat loss. Remove wet garments, if possible, and insulate or shield the person from wind, heat or cold. The person should not be defibrillated in water. CPR or defibrillation should not be withheld to re-warm the person. Responders should handle people with hypothermia gently, as shaking them could result in V-fib.
AEDs and Pacemakers and Implantable Cardiac Devices. Some people whose hearts are weak and not able to generate an electrical impulse may have had a pacemaker implanted. The pacemaker serves the function of the sinoatrial (SA) node, which is the natural pacemaker. These small implantable devices may sometimes be located in the area below the right collarbone. There may be a small lump that can be felt under the skin. Sometimes, the pacemaker is placed somewhere else. Other individuals may have an implantable cardioverter-defibrillator (ICD), a miniature version of an AED, which acts to automatically recognize and restore abnormal heart rhythms. If visible, or you know that the person has an implanted cardiac device or pacemaker, do not place the defibrillation pads directly over the implanted device. This may interfere with the delivery of the shock. Adjust pad placement if necessary, and continue to follow the established protocol. If you are not sure, use the AED if needed. It will not harm the person or responder. Responders should be aware that it is
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possible to receive a mild shock if an ICD delivers a shock to the person while CPR is performed. This risk of injury to rescuers is minimal and the amount of electrical energy involved is low. Much of the electrical energy is absorbed by the persons own body tissues. Some protocols may include temporarily deactivating the shock capability of an ICD with a donut magnet or other precautions. Responders should be aware of and follow any special precautions associated with ICDs but should not delay performing CPR and using an AED.
attempt to put the person on a dry surface, such as a backboard. The persons chest should be wiped dry. If possible, the person should be placed on a backboard and moved away from the water. Proceed to use the defibrillator as in any situation.
Transdermal Medication Patches and AEDs. Some patients may use a transdermal medication patch. The most common of these patches is the nitroglycerin patch, used by those with a history of cardiac problems. These patches are usually placed on the chest. If you encounter a person with a patch on his or her chest, remove it with a gloved hand. Nitroglycerin and other medication patches pose a possible absorption risk for responders, not an explosion hazard. Nitroglycerin patches look very similar to nicotine patches that people use to stop smoking. Although these patches do not interfere with defibrillation, time may be wasted attempting to identify the type of patch. Therefore, any medication patches on the persons chest should be removed. Never place AED electrode pads directly on top of medication patches. Trauma and AEDs. If a person is in cardiac arrest resulting from traumatic injuries, the AED may still be used. Defibrillation should be administered according to local protocols. AEDs Around Water. AEDs can be used in a variety of environments including rain and snow. Always use common sense when using an AED and follow the manufacturers recommendations. Generally, the person should not be in a puddle of water, nor should the responder be kneeling in a puddle of water when operating the AED. If it is raining, steps should be taken to ensure that the person is as dry as possible and sheltered from the rain. Ensure that the persons chest (and back of a smaller child if using anterior/ posterior pad placement) is wiped dry. However, minimize delaying defibrillation when taking steps to provide for a dry environment. The electric current of an AED is directional between the electrode pads, and AEDs are very safe when all precautions and manufacturers operating instructions are followed. When using an AED near water, such as at a pool facility,
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Chest Hair. Some men have excessive chest hair that may cause difficulty with pad-to-skin contact. Since time to first shock is critical, and chest hair rarely interferes with pad adhesion, attach the pads and analyze the hearts rhythm as soon as possible. Press firmly on the pads to attach them to the persons chest. If you get a check pads or similar message from the AED, remove the pads and replace with new ones. The pad adhesive may pull out some of the chest hair, which may solve the problem. If you continue to get the check pads message, remove the pads, shave the persons chest and attach new pads to the persons chest. Spare defibrillation pads and a safety razor should be included in the AED kit. Be careful not to cut the person while shaving, as cuts and scrapes can interfere with rhythm analysis. Jewelry and Body Piercings. Jewelry and body piercings do not need to be removed when using an AED. These are simply distractions that do no harm to the person, but taking time to remove them delays delivery of the first shock. Do not delay the use of an AED to remove jewelry or body piercings. Do not place the defibrillation pad directly over metallic jewelry or body piercings. Adjust pad placement if necessary and continue to follow established protocols. Other AED Protocols. Other AED protocols are neither incorrect nor harmful, for example, delivering three shocks and then performing CPR. However, improved methods based on new scientific evidence make it easier to coordinate CPR with use of the AED. Follow the instructions of the AED you are using, whether it is to give 1 shock and then perform CPR or to give 3 shocks followed by CPR.
Note: Metal surfaces are not included as a special circumstance because they do not pose a shock hazard to either a person or a responder. Additional information provided by AED manufacturers conrms that it is safe to debrillate a person on a metal surface as long as the appropriate safety precautions are taken. Specically, care should be taken that the debrillation electrodes do not contact the conductive surface and that no one is touching the person when the shock button is pressed.
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Maintenance of AEDs
For defibrillators to function optimally, they must be maintained like any other machine. The AEDs that are available today require minimal maintenance. These devices have various self-testing features. However, it is important that operators are familiar with any visual or audible warning prompts the AED may have to warn of malfunction or a low battery. It is important that you read the operators manual thoroughly and check with the manufacturer to obtain all necessary information regarding maintenance. In most instances, if the machine detects any malfunction, you should contact the manufacturer. The device may need to be returned to the manufacturer for service. While AEDs require minimal maintenance, it is important to remember the following:
for periodic equipment checks, including checking the batteries and defibrillation pads.
Make sure that batteries have enough energy for one complete rescue. (A fully charged back-up battery should be readily available.) Make sure that the correct defibrillator pads are in the package and are properly sealed. Check any expiration dates on defibrillation pads and batteries and replace as necessary. Properly dispose of any pads that have passed their expiration date whether they have been used or not. After use, make sure that all accessories are replaced and that the machine is in proper working order. If at any time the machine fails to work properly or warning indicators are recognized, discontinue use, place it out of service and contact the manufacturer immediately.
Follow the manufacturers specific recommendations and your facilitys schedule
AEDs and Oxygen

When using AEDs in conjunction with administration of emergency oxygen, follow these guidelines:

intentionally or unintentionally, which could reach potentially dangerous levels.
Avoid the use of free-flowing oxygen and the use of an AED in a confined space. Before shocking a person with an AED, ensure that no one is touching or in contact with the person or the resuscitation equipment. Keep breathing devices with free-flowing oxygen away from the person during defibrillation. Follow local protocols.
Conned space is a space that: Is confined because the configurations hinder the activities of employees who must enter, work in and exit the space. Has limited or restricted means of entry or exit (e.g., tanks, vessels, silos, storage bins, hoppers, vaults and pits). Is not designed for continuous employee occupancy.
Denitions
Free-owing oxygen is defined as any oxygen that is released into the environment either
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VIDEO SEGMENTS FOR THE RESPONDING TO EMERGENCIES COURSE

Introduction

Introduction (2:13) What Would You Do? (1:36)
Assessment

The Human Body (15:16) Checking an Unconscious Adult and Child (3:36) Checking an Unconscious Infant (1:51)
Life-Threatening Emergencies: Cardiac Emergencies

Recognizing and Caring for Cardiac Emergencies (4:28) CPRAdult and Child (7:46) Putting It All Together: CPRAdult (2:03) CPRInfant (6:51) Putting It All Together: CPRInfant (1:52) Using an AED (4:45)
Life-Threatening Emergencies: Breathing Emergencies

Conscious ChokingAdult and Child (2:25) Conscious ChokingInfant (1:56) Unconscious ChokingAdult and Child (2:19) Unconscious ChokingInfant (1:36) Assisting with an Asthma Inhaler (3:08)
Life-Threatening Emergencies: Bleeding and Shock

Controlling External Bleeding (2:28) Shock (1:52)
Injuries

Injuries to Muscles, Bones, and Joints (1:41) Splinting (5:07)
Medical Emergencies

Recognizing Sudden Illness (8:27) Assisting with an Epinephrine Auto-Injector (2:56)
Optional Video Segments

Bloodborne Pathogens Training: Preventing Disease Transmission (16:59) The Hearts Electrical System (5:35)
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Hands-Only CPR (1:42) Using a Manufactured Tourniquet (1:22)
Instructor Training Segments

Introduction (1:53) Preparing to Conduct a Skill Session (4:14) How to Conduct a Skill Session (2:02) How to Use Video Support (5:09) Observing and Evaluating Skill Performance (5:07) The Critical Eye (4:47) Conducting Scenarios (4:04)
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FREQUENTLY ASKED QUESTIONS ABOUT FIRST AID, CPR AND AED

Lesson 3: If Not You Who?
Coping with the Emotional Aspects of Giving Care
Q: How can I cope with the emotional aspects of giving care to someone in an emergency? A: Being involved in the rescue of another person can cause a wide range of feelings. These feelings are normal. It also is important to know that talking about your feelings is helpful in coping with the stress of responding to someone in an emergency situation. You may wish to talk with family members, consult your human resources department about your companys employee assistance program or consult your personal health care provider or clergy for counseling or referral to a professional.
Lesson 4: Taking Action

Checking the Scene
Q: What is a confined space? A: The Occupational Safety and Health Administration (OSHA) considers a confined space as a space that:

Is confined because the configurations hinder the activities of employees who must enter, work in and exit the space. Has limited or restricted means of entry or exit (e.g., tanks, vessels, silos, storage bins, hoppers, vaults and pits). Is not designed for continuous employee occupancy.
Q: If I am checking the scene for safety, what dangerous situations may prevent me from reaching the person? A: Some scenes may be unsafe for obvious reasons, such as fire, smoke-filled spaces or traffic. You should also avoid going into areas that require special training and equipment (e.g., respirators, self-contained breathing apparatus). This includes a poisonous gas environment, possible explosive environment (e.g., natural gas or propane), collapsed or partially collapsed structures and confined areas without ventilation or fresh air.
Lesson 5: Before Giving Care

Contaminated Materials
Q: What is considered to be contaminated by blood? A: Materials contaminated by blood include:

Items that when compressed release blood in either a liquid or semi-liquid state. Items caked with blood that will, or may, release the blood when handled.
Q: How do I dispose of contaminated materials if my workplace does not have a biohazard container? A: If a biohazard container is not available, a double-lined plastic bag may be used. A workplace health and safety officer or the local health department should be contacted regarding procedures and regulations for disposal.
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Q: What happens to the biohazard container after contaminated materials have been disposed of? A: A workplace should have a plan in place to properly dispose of contaminated material. Some workplaces work with their local medical facility, public health unit or another contracting agency for disposal of the containers. For additional information, contact your workplace health and safety officer or OSHA.
Preventing Disease Transmission

Q: Do I have to worry about all body fluids, even saliva and tears? A: Yes. Even though there is a decreased risk of transmission of infectious materials in saliva and tears, precautions should be taken whenever there is contact with a persons body fluids. Q: Can the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), be spread by touching a person? A: No. HIV cannot be spread by touching a persons unbroken skin. HIV is known to be transmitted only through exposure to infected blood, semen, vaginal secretions and breast milk. Q: How is hepatitis B virus (HBV) transmitted? A: HBV is most often transmitted through unprotected direct or indirect contact with infected blood or body fluids. HBV is not transmitted by casual contact, such as by shaking hands, or indirectly contacting objects, such as drinking fountains or telephones. High-risk activities and situations include:

Sex with an infected partner. Injection drug use that involves sharing needles, syringes or drug-preparation equipment. Birth to an HBV-infected mother. Contact with blood or open sores of an infected person. Needlesticks or sharp instrument exposures. Sharing items, such as razors or toothbrushes, with an infected person.
(Source: Centers for Disease Control and Prevention, www.cdc.gov/hepatitis/) Q: How is hepatitis C virus (HCV) transmitted? A: HCV is transmitted primarily by direct contact with human blood, through sexual contact and from mother to child at birth. High-risk activities and situations include:

Injection drug use (currently, the most common means of HCV transmission in the United States). Receipt of donated blood, blood products and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992). Needlestick injuries in health care settings. Birth to an HCV-infected mother. Sex with an HCV-infected person (an inefficient means of transmission, so spread is infrequent). Sharing personal items contaminated with infectious blood, such as razors or toothbrushes (also an inefficient means of transmission). Other health care procedures that involve invasive procedures, such as injections (usually recognized in the context of outbreaks).
(Source: Centers for Disease Control and Prevention, www.cdc.gov/hepatitis/)
Good Samaritan Laws and Consent

Q: My workplace deals with children. Do I need to get consent from a child to give care? A: No. Implied consent applies to children who obviously need emergency help when a parent or guardian is not present. When a parent or legal guardian registers a child for a child-care program, many states require that
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the caregiver inform the parent about the programs policy on first aid/emergency care and ask the parent to complete a consent and contact form.
Lesson 7: Checking an Unconscious Person

Checking an Unconscious Adult, Child or Infant
Q: How long should you check for breathing? A: You should check for breathing for no more than 10 seconds. Q: What is normal breathing? A: Normal breathing is regular, quiet and effortless. Infants have periodic breathing, so changes in pattern of breathing are normal. Isolated or infrequent gasping in the absence of other breathing in an unconscious person may be agonal gasps, which can occur after the heart has stopped beating. Agonal gasps are not breathing. Since reducing time without chest compressions is so important, rescuers should decide in favor of doing chest compressions if there is any doubt that a victim is breathing. Q: What if the person is face-down? A: If the person is face-down, check for responsiveness, call 9-1-1 or the local emergency number, and then roll the person onto his or her back and quickly check for breathing. Q: What if I am alone? A: If you are alone:
Call First (call 9-1-1 or the local emergency number before giving care) for: Any adult or child about 12 years of age or older who is unconscious. A child or an infant whom you saw suddenly collapse. An unconscious child or infant who you know has heart problems.
Care First (give 2 minutes of care, then call 9-1-1 or the local emergency number) for: An unconscious child (younger than about age 12) whom you did not see collapse. Any drowning victim.
Q: Do I skip the check for bleeding for a child and an infant if the breaths do not go in on the initial breaths? A: Quickly scan for severe bleeding as you are moving into position to give chest compressions. Q: For drowning or other noncardiac conditions (e.g., hypoxia) in adults, does the assessment change? A: Yes. You would give 2 rescue breaths after checking for breathing. Q: What if the rescue breaths go in after removing the foreign object? A: Recheck the person for breathing and give care as needed. Q: For a witnessed, sudden collapse of a child, does the assessment change? A: Yes. After opening the airway and checking for breathing, immediately begin CPR, starting with chest compressions.
Checking an Unconscious Infant

Q: How much air should I blow when giving rescue breaths? A: Just enough to make the chest clearly rise. Q: How long should I pause between the initial 2 rescue breaths? A: You should pause just long enough to take in air to give the second breath.
DRAFT
Lesson 8: Checking a Conscious Person

Q: Why is it important to ask the conscious person questions that advanced medical personnel will ask anyway? A: A persons condition may worsen, and he or she may be unconscious by the time advanced medical personnel arrive. The persons answers to your questions may provide valuable information that would otherwise be unavailable. Q: What if a person is just barely conscious and groggy or confused? A: A person who is barely conscious and groggy or confused may have a life-threatening injury or illness. Call 9-1-1 or the local emergency number. Stay with the person and monitor his or her condition until advanced medical care arrives.
Lesson 9: Cardiac Emergencies

Heart Attacks
Q: Ive read on the Internet that if I am having a heart attack, I should try cough CPR. Is that a good idea? A: To date, there is insufficient scientific evidence supporting self-initiated CPR (also known as cough CPR). Instead, emphasis should be placed on recognizing the signals of a heart attack and calling 9-1-1 or the local emergency number immediately. Q: If I suspect that I am having a heart attack, should I take aspirin? A: Taking aspirin should never take precedence over calling 9-1-1 or the local emergency number if you experience signals of a heart attack. Before you have any signals of a heart attack, check with your health care provider to be sure that it is appropriate for you to take aspirin. If so, for a person having a heart attack, taking aspirin after calling 9-1-1 can have a beneficial effect. Q: What if the person having a heart attack takes nitroglycerin? A: Help a conscious person take any prescribed nitroglycerin for a known heart condition. Quick-acting forms of nitroglycerin used in an emergency include tablets (a sublingual tablet is placed under the tongue) and sprays.
Lessons 1012: CPR

CPR
Q: What do I do if I get tired while performing CPR? A: If one responder gets tired while waiting for advanced medical personnel to arrive, he or she may ask another trained responder to take over. The second responder should begin with chest compressions and then breaths. If performing hands-only CPR, the second responder should continue with compressions. Q: Can I perform CPR on a person who is on a bed or couch? A: No. For chest compressions to be most effective, the person should be on a firm, flat surface, with the persons head on the same level or lower than the heart. If the person is on a soft surface, such as a bed or a couch, move him or her to the firm, flat surface. Q: Should my hand position be different when giving compressions to a pregnant woman? A: Yes. Place your hands slightly higher on the chest (toward the womans head).
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Q: If I am doing chest compressions and I hear bones cracking, should I stop? A: Ribs may be broken during CPR. Continue doing CPR, but quickly check your hand position and the depth of compressions to be sure that you are doing the compressions properly. Sometimes, the sound you hear is not bone cracking but cartilage separating. For a person whose heart has stopped, the benefits of CPR outweigh the risks, even when bones break. Q: What if I am unable, for whatever reason, to give both rescue breaths and chest compressions? A: If you are unable for any reason to perform full CPR (chest compressions with rescue breaths), give continuous chest compressions until another trained responder or emergency medical services (EMS) personnel take over or you notice an obvious sign of life. Q: When CPR is required, do I need to bare the chest? A: If you can give effective compressions, you do not need to bare the chest. If clothing interferes with your ability to either locate the correct hand position or give effective compressions, then you should remove or loosen enough clothing to allow effective compressions. Q: What is commotio cordis? A: The National Athletic Trainers Association states that commotio cordis is a condition caused by a blow to the chest (directly over the heart) that occurs between heart contractions. The blunt force causes a lethal abnormal heart rhythm. Q: What if the person vomits? A: If at any time the person vomits, quickly roll him or her onto the side, as you support the head and neck and roll the body as a unit. After vomiting stops, wipe the persons mouth out using a finger sweep. Roll the person onto his or her back and continue giving care. Q: What does just below the nipple line mean for finger placement when performing CPR on an infant? A: Fingers should be in the center of the infants chest just below the nipple line (with fingers toward the infants feet). Q: Why might the chest not rise? A: The chest may not rise because:

The head is not in the correct position, thereby causing the tongue to block the airway. A good seal was not established with the CPR breathing barrier. The rescuer blows too quickly. The airway is blocked by a foreign object.
Q: What if the rescue breaths go in after I remove a foreign object? A: Recheck the person for breathing and give care as needed. Q: When should I use an AED? A: Use an AED as soon as one becomes available. If alone, get the AED activated and in use as fast as possible. If a second responder brings the AED, minimize interruption of CPR until the AED begins analysis.
Lessons 14 and 15: AED

Q: If the location of the pads on the chest is reversed, will the AED still work? A: Yes. If the placement of the pads is reversed, the AED will still work properly. Q: Should the pads be removed and/or the AED turned off if the AED prompts, No shock advised, continue CPR (or similar)? A: No. The pads should not be removed, nor should the AED be turned off. It is possible that the AED will tell you that additional shocks are needed.
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Q: Should I use pediatric AED pads on an adult? A: No. Pediatric AED pads should not be used on an adult, as they may not deliver enough energy for defibrillation. Q: Do AEDs need regular maintenance? A: Yes. All AEDs require regular maintenance. Maintenance includes checking and changing batteries and electrode cables and pads. Always follow the manufacturers instructions for maintenance of the AED at your worksite. Q: Can AEDs be used safely in the rain and snow? A: AEDs can be used in a variety of environments, including rain, snow and ice. When using an AED, always follow the manufacturers recommendations. Generally, the person should not be lying in a puddle of water, nor should the responder be kneeling in a puddle of water when operating the AED. If it is raining, ensure that the person is as dry as possible and sheltered from the rain. Minimize delaying defibrillation when providing a dry environment. Wipe the persons chest (and back of a smaller child, if using anterior/posterior pad placement). Manufacturers state that AEDs are safe when all precautions and operating instructions are followed. Q: Can I defibrillate someone who has a pacemaker or other implantable cardiac device? A: Yes. If an implanted cardiac device is visible or you know that the person has such a cardiac device, do not place the defibrillation pads directly over the implanted device. This may interfere with the delivery of the shock. Adjust pad placement if necessary and continue to follow the established protocol. Q: Are there any special considerations when placing electrode pads on a female? A: If the female is wearing a bra, remove it before placing the electrode pads. As for all individuals, place one electrode pad on her upper right chest and one on her lower left side under her breast. Q: Can I defibrillate a pregnant woman? A: Yes. Defibrillation shocks transfer no significant electric current to the fetus. Local protocols and medical direction should be followed. Q: Can AEDs be used on young children and infants? A: Certain AED equipment and electrode pads that are specifically designed to deliver lower energy levels for pediatric persons (children and infants) have been approved by the Food and Drug Administration (FDA) and are recommended for use on infants in cardiac arrest by the American Academy of Pediatrics (AAP). AEDs are appropriate for use on anyone in cardiac arrest, regardless of age, including children as young as newborns. When pediatric settings or pads are available, responders should use them when treating children and infants. If pediatric equipment is not available, responders may use AEDs configured for adults. An AED should be used along with high-quality CPR. Q: Where can I purchase an AED for my company, school or home? A: Contact the American Red Cross or go to the Red Cross Store (redcrossstore.org) for information on how to purchase an AED. Q: Do I need to be trained in AED? A: The steps in applying and using an AED are simple; however, training is important to know when to use the AED and to understand the safety precautions associated with the AED.
Lesson 18: Conscious ChokingAdult and Child

Conscious ChokingAdult and Child
Q: What should I do if a conscious choking adult or child becomes unconscious? A: If the person becomes unconscious, carefully help the person to the floor. Then check for an object in the mouth. If the object is visible, remove it with a finger. If no object is seen, open the persons airway and try to give 2 rescue breaths. If the chest does not clearly rise, begin cycles of giving 30 chest compressions, looking for a foreign object and giving 2 rescue breaths.
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Q: Should I call 9-1-1 or the local emergency number for a conscious choking person? A: Yes. Even if a foreign object does come out, there is a chance that tissue in the persons airway may swell and cause further complications. If the object does not come out, the person may become unconscious and need additional care. Q: What if I am alone and choking? A: Call 9-1-1 or the local emergency number, even if you cannot speak, and do not hang up the phone. You can give yourself abdominal thrusts. Bend over a firm object, such as the back of a chair or a railing, and press your abdomen against it. Avoid a sharp edge or corner that might hurt you. Q: Why should I give a combination of back blows and abdominal thrusts to a conscious adult or child who is choking? A: Based on the 2010 Consensus on Science for CPR and Emergency Cardiovascular Care, a combination of back blows and abdominal thrusts is more effective in clearing an obstructed airway than a single technique. Q: What if the choking person is pregnant, too large to reach around or in a wheelchair and cannot stand? A: If a person is pregnant, too large for you to stand behind and reach around his or her abdomen or in a wheelchair, give chest thrusts. To give chest thrusts, make a fist with one hand, grab your fist with the other hand, place the thumb side of your fist on the center of the persons breastbone and give quick thrusts into the chest. Q: What if the person choking is much shorter than I am? A: You may have to adjust your position and get down on one knee to give back blows and abdominal thrusts. Q: How hard should I perform abdominal thrusts on a child? A: You should thrust hard enough to produce an artificial cough that will dislodge the object.
Lesson 19: Conscious ChokingInfant

Q: What should I do if a conscious choking infant becomes unconscious? A: If the infant becomes unconscious, carefully place the infant on a firm, flat surface. Then, check for an object in the mouth. If the object is visible, remove it with a small finger. If no object is seen, open the infants airway and try to give 2 rescue breaths. If the chest does not clearly rise, begin cycles of giving 30 chest compressions, looking for a foreign object and giving 2 rescue breaths. Q: Should I call 9-1-1 or the local emergency number for a conscious choking infant? A: Yes. Even if a foreign object does come out, there is a chance that tissue in the infants airway may swell and cause further complications. If the object does not come out, the infant may become unconscious and need additional care.
Lesson 20: Unconscious ChokingAdult and Child

Q: What if the object does not come out? A: Continue cycles of 30 chest compressions, foreign object check/removal and 2 rescue breaths until the object is removed and the chest clearly rises with rescue breaths, you are able to get breaths in and see the chest clearly rise, the person starts breathing on his or her own or advanced medical personnel take over.
DRAFT
Q: What happens if the object comes out but the adult or child is still not breathing? A: Once an object is removed, be sure to give 2 rescue breaths to verify that the airway is open and clear. Then, check for breathing. Also, make sure that 9-1-1 or the local emergency number has been called. If the person is not breathing, begin CPR. Continue giving care until advanced medical personnel take over.
Lesson 21: Unconscious ChokingInfant

Q: What if the object does not come out? A: Continue cycles of 30 chest compressions, foreign object check/removal and 2 rescue breaths until the object is removed and the chest clearly rises with rescue breaths, you can get air into the infant and see the chest clearly rise, the infant starts breathing on his or her own or advanced medical personnel take over. Q: What happens if the object comes out, but the infant is still not breathing? A: Once an object is removed, give 2 rescue breaths to verify that the airway is open and clear. Then, check for breathing. Also, make sure that 9-1-1 or the local emergency number has been called. If there is no breathing, begin CPR. Continue giving care until advanced medical personnel take over.
Lesson 22: Bleeding

Controlling External Bleeding
Q: If no sterile or clean dressings are available, what other materials could I use to cover a bleeding wound? A: Other materials, such as clean washcloths, towels or articles of clothing, can be used to cover a bleeding wound. Materials that are clean and absorbent are best. Do not use paper towels, tissues, cotton balls or other material that can tear easily. Q: What if I do not have any fresh, running tap water to irrigate a minor wound? A: You can use any source of clean water to irrigate a minor wound, but clean tap water (under pressure) is more effective at removing dirt and debris. Q: If disposable gloves are not available, should I still give care to someone who is bleeding severely? A: Although the risk of disease transmission is low, it exists, and therefore this should be a personal decision. Wearing gloves is recommended, but you may choose to give care without them. You could use other materials, such as a bulky dressing. A barrier should be used to limit your contact with the persons blood. If conscious and able, the person can assist by applying direct pressure to the wound with his or her hand. Avoid touching your face and other parts of your body when giving care. Always wash your hands thoroughly with soap and water immediately after giving care. If gloves were unavailable and you gave care in a workplace emergency situation, report the situation to your supervisor as a possible exposure to infectious diseases. Q: Should a tourniquet be used to control bleeding? A: A tourniquet is a tight band placed around an arm or a leg to constrict blood vessels, which stops blood flow to a wound. Because of the potential for adverse effects, a tourniquet should be used only as a last resort in cases of delayed-care or delayed EMS response situations when direct pressure does not stop the bleeding or you are not able to apply direct pressure. Q: Why do we no longer use pressure points or elevation to stop bleeding? A: More emphasis is being placed on direct pressure as it is the most effective method of controlling external bleeding. The scientific evidence does not support the use of pressure points or elevation to control external bleeding. Using these methods may distract the responder from applying the proven, effective technique of direct pressure.
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Lesson 23: Internal Bleeding/Shock

Internal Bleeding
Q: Can I use a reusable gel pack on a soft tissue injury if I do not have an ice pack? A: An ice pack (a mixture of ice and cold water) is preferred. Single-use, chemical cold packs are effective, but reusable gel packs are less effective in reducing swelling in a soft tissue injury.
Shock
Q: Should I give a person showing signals of shock something to eat or drink? A: No. Do not give the person anything to eat or drink, even though he or she is likely to be thirsty. The persons condition may be severe enough to require surgery, in which case it is better that the stomach is empty.
Lesson 25: Soft Tissue Injuries I

Care for Closed Wounds
Q: Can I use a reusable gel pack on a soft tissue injury if I do not have an ice pack? A: An ice pack (a mixture of ice and cold water) is preferred. Single-use, chemical cold packs are effective, but reusable gel packs are less effective in reducing swelling in a soft tissue injury.
Care for Open Wounds

Q: If sterile or clean dressings are not available, what other materials could I use to cover a bleeding wound? A: Other materials, such as clean washcloths, towels or articles of clothing, can be used to cover a bleeding wound. Materials that are clean and absorbent are best. Do not use paper towels, tissues, cotton balls or other material that can tear easily. Q: What if I do not have any fresh, running tap water to irrigate a minor wound? A: You can use any source of clean water to irrigate a minor wound, but clean tap water (under pressure) is more effective at removing dirt and debris. Q: If disposable gloves are not available, should I still give care to someone who is bleeding severely? A: Although the risk of disease transmission is low, it exists; therefore, this should be a personal decision. Wearing gloves is recommended, but you may choose to give care without them. You could use other materials, such as a bulky dressing. A barrier should be used to limit your contact with the persons blood. If conscious and able, the person can assist by applying direct pressure to the wound with his or her hand. Avoid touching your face and other parts of your body when giving care. Always wash your hands thoroughly with soap and water immediately after giving care. If gloves were unavailable and you gave care in a workplace emergency situation, report the situation to your supervisor as a possible exposure to infectious diseases. Q: How do I know if a wound needs stitches? A: Stitches are often needed when the edges of the skin do not fall together, when the wound is over inch long or when the wound would leave an obvious scar, such as on the face. Control the bleeding and have the person seek advanced medical care. Q: Should a tourniquet be used to control bleeding? A: A tourniquet is a tight band placed around an arm or a leg to constrict blood vessels, to stop blood flow to a wound. Because of the potential for adverse effects, a tourniquet should be used only as a last resort in
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cases of delayed-care or delayed EMS response situations when direct pressure does not stop the bleeding or you are not able to apply direct pressure.
Lesson 26: Soft Tissue Injuries II/ Musculoskeletal Injuries I

Burns
Q: Should I put water on an electrical burn? A: Yes. Care for electrical burns is the same as care for thermal (heat) burns (cold water). Q: Can I put ointment or other medications on a burn? A: No. Do not put any kind of ointment or salve on anything other than a very minor burn. Ointments do not relieve pain and can also seal in heat. Do not use home remedies, such as butter or petroleum jelly (which can cause infection), on a burn. Cold water is best to cool the burn and reduce pain. Q: If the persons burned clothing is stuck on his or her body, should I try to remove it? A: No. Do not try to remove any clothing that is sticking to the person because you could further expose the wound to infection.
Lesson 27: Musculoskeletal Injuries II and Splinting

Care for Musculoskeletal Injuries
Q: Why do you not cover the fracture site with bandages when splinting a fracture? A: Excessive pressure applied to a fracture site can complicate the injury. It is unnecessary to cover a fracture unless there is bleeding. Q: How do you control bleeding when it is associated with an open fracture? A: Apply dressings and light pressure around the area of the open wound to control bleeding. Do not move the injured area.
Splinting
Q: Why is it better to leave the persons shoe on when splinting an ankle? A: The shoe can act as a splint and minimize swelling. Also, removing the shoe may require manipulating the ankle and should be done only by health care providers.
Lesson 28: Injuries to the Head, Neck and Spine

Head, Neck and Spinal Injuries
Q: If I suspect that a person has a head, neck or spinal injury and the person starts to vomit, what do I do? A: If the person begins to vomit, roll him or her on one side to keep the airway clear. To minimize movement of the persons head, neck and spine, two responders should place the person in this position, if possible. One responder should help move the person while the other keeps the head, neck and spine in line.
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Lesson 30: Sudden Illness

Fainting
Q: What care do I give for someone who has fainted? A: Position the person on a flat surface. Check that the person is breathing. Loosen any restrictive clothing. Do not give the person anything to eat or drink. Do not splash water on the person or slap his or her face. Call 9-1-1 or the local emergency number.
Diabetic Emergency
Q: How do I recognize if someone who is a diabetic has too much sugar (hyperglycemia) or not enough sugar (hypoglycemia)? A: The signals for the two conditions are similar. The first aid care given is the same for both conditions. If the problem is hypoglycemia, the persons condition can get worse rapidly, and administering sugar in the form of several glucose tablets or glucose paste, a 12-ounce serving of fruit juice, milk, nondiet soft drink or table sugar dissolved in a glass of water can improve the persons condition. If the problem is hyperglycemia, the persons condition will get gradually worse. Giving these forms of sugar will not speed up the deterioration significantly. If the person is conscious and able to swallow, there is time to get medical care if the persons condition does not improve quickly.
Seizures
Q: Should I try to hold down someone who is having a seizure? A: No. Do not try to hold down a person who is having a seizure. Your primary care objective is to protect the person from any further injury. Keep the person from striking any nearby objects and keep the airway open after the seizure has ended. Q: When should I call 9-1-1 or the local emergency number for someone having a seizure? A: Although most seizures are not life threatening, call advanced medical care if the seizure lasts more than 5 minutes; the person has repeated seizures with no signs of slowing down; you are uncertain about the cause or this is the persons first seizure; the person is pregnant or diabetic; the person is a child or an infant; the seizure takes place in the water; the person fails to regain consciousness after the seizure; the person is a child or an infant who experienced a febrile seizure brought on by a high fever; the person is elderly and could have suffered a stroke; or the person becomes injured or shows other life-threatening conditions. Q: Should I put something in the persons mouth to keep him or her from biting the tongue? A: No. Do not place anything in the persons mouth or between his or her teeth. Placing an object in the persons mouth is ineffective because most tongue biting occurs at the beginning of a seizure and trying to place an object in the mouth may cause mouth injuries or aspiration. You may become injured while placing an object in a persons mouth, as well. Q: What is a febrile seizure? A: Febrile seizures are seizures brought on by a rapid increase in body temperature. They are most common in children younger than age 5.
Stroke
Q: What are the risk factors for stroke? A: Risk factors for stroke are similar to those for heart disease. The most important risk factors for stroke that can be controlled are high blood pressure, high blood cholesterol, poor diet, physical inactivity and obesity, diabetes and smoking. Some risk factors are beyond your control, such as age, gender, family history of stroke, race or previous stroke, transient ischemic attack (TIA) and heart attack.
DRAFT
Q: Is there any treatment for stroke? A: Today, medical treatments are available that can reduce or even prevent the long-term effects of a stroke. It is vital to give these treatments as soon as possible after a stroke has occurred. The emphasis should be on calling 9-1-1 or the local emergency number immediately if you suspect that someone is having a stroke.
Lesson 31: Sudden Illnesses II/Poisoning

Poisoning
Q: Should I try to induce vomiting if a person has ingested a poison? A: No. You should call 9-1-1 or the National Poison Control Center (PCC) hotline at 800-222-1222. The emergency medical dispatcher or call taker or the PCC operator will know the proper actions that should be taken, depending on the type of poison that was ingested. Q: Should I give a person who ingested a poison water or milk to drink? A: No. Do not give anything by mouth unless advised to by a medical professional or the PCC. Q: Should I give a person who ingested a poison activated charcoal? A: No. You should call 9-1-1 or the PCC hotline at 800-222-1222. The emergency medical dispatcher or call taker or the PCC operator will know the proper actions that should be taken, depending on the type of poison that was ingested.
Allergic Reaction
Q: What care should I give to someone who has trouble breathing because of an allergic reaction? A: The person may be experiencing a type of severe allergic reaction called anaphylaxis. Call 9-1-1 or the local emergency number immediately, place the person in a comfortable position for breathing, and comfort and reassure the person until advanced medical personnel take over. In some cases, you may need to help the person use his or her epinephrine auto-injector.
Lesson 34: Heat-Related Illnesses and Cold-Related Emergencies

Heat-Related Illnesses
Q: Can a heat-related illness occur on a cold day? A: Yes, if a person has been exercising or performing a stress-related activity that may cause the body to lose fluids. Q: Should you give a sports drink to a person who is suffering from heat cramps or heat exhaustion? A: Yes. Give a person experiencing heat cramps, dehydration or heat exhaustion small amounts of an electrolyte/ carbohydrate-containing fluid, such as a commercial sports drink, fruit juice or milk, as long as he or she is conscious and able to swallow. Water may also be given. For heat exhaustion, give about 4 ounces every 15 minutes.
Cold-Related Emergencies
Q: Should you rub a frostbitten body part to warm it up? A: No. Never rub a body part that may be frostbitten. Rubbing can cause extensive, painful soft tissue damage. Do not attempt to re-warm the frostbitten area if there is a chance that it could refreeze or if you are close to a medical facility. Q: Should I give fluids to drink that contain alcohol or caffeine to a person who is in a cold environment? A: No. Alcohol and caffeine interfere with the bodys normal response to cold and make a person more susceptible to hypothermia.
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INDEX
Note: Italicized page numbers indicate Skill Charts and Skill Assessment Tools 9-1-1 call, 27, 28, 34, 35, 49 A abdominal cavity, 45 abdominal injury, 19091 abdominal pain in children and infants, 256 abdominal thrusts for adult and child, 119 abrasion, 153 adult cardiopulmonary resuscitation for, 6667, 6869 checking unconscious, 5051, 52 conscious choking in, 11619, 120, 33536 rescue breaths for unconscious, 50 signals of respiratory distress in, 112, 113 unconscious choking in, 12527, 12829, 33637 AED. See Automated external defibrillator airway obstruction, 1089 alcohol, 22324, 248 allergic reaction, 111, 341 See also Anaphylaxis Alzheimers disease, 261 American Red Cross additional courses of, 7 resources of, 3 retail products of, 7 Americans with Disabilities ActCourse Modications, 10 amphetamine, 222 amputation, 154 anabolic steroid, 225 anaphylaxis, 111, 113, 2089 anatomical positions, 45 angina pectoris, 63 animal bite, 21819 See also Bites and stings ankle and foot injury, 172 ankle drag, 41 anorexia nervosa, 226 aquatic emergency. See Water-related emergency arm injury. See Extremity injury, upper arterial bleeding, 136 aspirin, 225, 259, 331 assist. See Rescues and assists asthma, 113, 114 Authorized Provider or Licensed Training Provider Agreement, 3 automated external defibrillator (AED), 8182, 322 for adult, 82, 85 adult skill practice and scenarios for, 8790, 9293 for child and infant, 9596, 9798, 32223 child and infant skill practice and scenarios for, 99103, 1067 frequently asked questions about, 33435 maintenance of, 327 operation and pad placement for, 32425 oxygen and, 327 safety precautions for using, 8283 special resuscitation situations and, 32526 avulsion, 154 B Babesia infection, 21314 back blows for adult and child, 119 for infant, 122 back injury. See Lower back injury bandage, 155 beach drag, 251 Behavior Modification Contract, 22 bites and stings, 212, 220 prevention of, 21920 signals and care for specific, 21219 See also Poisons, injected; individual types of bites and stings black widow spider bite, 215, 216 blanket drag, 41 bleeding and blood, 136 See also External bleeding; Internal bleeding Bloodborne Pathogens Training course, 38 blood contamination, 38, 33031 body cavity, 45 body piercings and AED, 83, 326 body systems interrelationships among, 47 scenario for, 46 body temperature, 23031 botulism, 205 brain attack. See Stroke brain injury. See Concussion B.R.A.T. (bananas, rice, applesauce, toast), 257 Braxton Hicks contraction, 267 breathing emergency, 1089, 115 asthma and, 114 causes of, 109 respiratory distress and arrest as, 10914 See also Choking breech birth, 271 bronchitis, 11011 brown recluse spider, 215, 216 bulimia, 226 burns, 160, 165 care for, 16163 classification of, 160 critical, 161 in disaster, remote and wilderness emergencies, 281 frequently asked questions about, 339 severity of, 160 signals of, 160 bystanders, 27 C Call and Care (emergency action steps), 3435 cannabis products, 22425 capillary bleeding, 136 carbon monoxide poisoning, 206 cardiac arrest, 6364, 65, 322 in adults, 322
402
Instructors Manual
DRAFT
in children, 70, 323 in infants, 75, 323 Cardiac Chain of Survival, 6364 cardiac emergencies, 60, 64 angina pectoris and, 63 cardiac arrest and, 6364 frequently asked questions about, 333 heart attack and, 6152 cardiogenic shock, 143 cardiopulmonary resuscitation (CPR), 6566 for adults, 6667, 6869, 9192 for children, 7072, 7374, 1045 conditions for stopping, 67, 72, 77 definition of, 65 frequently asked questions about, 33334 for infant, 7577, 7879, 1056 role of, 323 for unconscious choking adult and child, 126 for unconscious choking infant, 131 cardiovascular disease, 60 caregivers, communicating with, 254 Cell phone. See Wireless phone cerebrovascular accident (CVA). See Stroke certificates, awarding of, 13 certification, 11 CHD. See Coronary heart disease Check-Call-Care (emergency action steps), 30, 31, 48, 51 cardiopulmonary resuscitation for adult and, 66 cardiopulmonary resuscitation for child and, 71 cardiopulmonary resuscitation for infant and, 76 in disaster, remote and wilderness emergencies, 27478, 28082 for shock, 144 Check (emergency action step), 3234 for possible head, neck and spinal injury, 179 scenarios for, 3134 of scene, 330 of unconscious person, 5051, 5254 cheek injury, 183 chemical burn, 16162 chest, abdomen and pelvis injuries, 18892 chest cavity. See Thoracic cavity chest hair and AED, 83, 326 chest injury, 189 chest pain. See Angina pectoris chest thrusts for adult and child, 118 continuous, 67 for infant, 122 See also Cardiopulmonary resuscitation child abuse and child neglect, 25657 childbirth, 26571 assessing labor in, 267 assisting with delivery in, 26869 caring for newborn and mother following, 26970 complications during, 271 scenario in, 26869 stages of labor in, 26667 child(ren), 254 automated external defibrillator for, 9596, 9798, 99103, 1067, 325 cardiopulmonary resuscitation for, 7072, 7374, 1045 characteristics of, 25455 checking conscious, 57 checking unconscious, 5354 common injuries and illnesses in, 25660 communicating with, 254 conscious choking in, 11619, 120, 33536 observation of, 255 poisons and, 204 rescue breaths for unconscious, 50 signals of respiratory distress in, 11213 unconscious choking in, 12527, 12829, 33637 choking causes of, 117 in conscious adult and child, 11619, 120, 33536 in conscious infant, 12123, 124, 336 signals of, 117 in unconscious adult and child, 12527, 12829, 33637 in unconscious infant, 13032, 13334, 337 universal sign for, 119 Chronic Obstructive Pulmonary Disease (COPD), 11011 classroom space, 8 class safety, 89 class size, 8 clavicle injury, 168 closed wound, 152, 158 care for, 153, 158, 338 signals of severe, 152 See also Internal bleeding clothes drag, 41 club drug, 223 cocaine, 223 co-instructor, 9 cold pack, 165, 338 cold-related emergency, 230, 238 frequently asked questions about, 341 older adults and, 261 people susceptible to, 231 prevention of, 235 types of, 23436 commotio cordis, 334 communication with children and caregivers, 254 language barriers to, 263 compressions. See Chest thrusts concussion, 182 confined space, 330 consciousness check for, 49 in head, neck and spinal injury, 181 conscious person, checking and caring for, 5558, 333 consent for emergency care, 39, 33132 continuing education units for professionals, 10 COPD. See Chronic Obstructive Pulmonary Disease coronary heart disease (CHD), 60 course content, 4 course evaluation, 13 course introduction, 1820 course outline, 1617 course participants, 2 criteria for assessment of, 1113 with disabilities and health considerations, 910, 319 health precautions for, 9, 31011 materials for, 4, 7, 313 progress log for, 320 with reading difficulties and disabilities, 319 Course Record, 13 course review, 28691 CPR. See Cardiopulmonary resuscitation cranial cavity, 45 croup, 111 crush injury, 154 crush syndrome, 154
Index
403
DRAFT
D decongestant, 225 defibrillation, 81, 322, 324 See also Automated external defibrillator dehydration, 23132 depressant, 22324 designer drug, 225 dextroamphetamine, 222 diabetes, 197 diabetic emergency, 19798, 340 diarrhea in children and infants, 257 disabilities, people with, 26263 disaster, remote and wilderness emergencies, 27273, 278, 285 caring for person in, 27982 difficult decisions in, 282 leadership and followership in, 27374 leaving person alone in, 277 modified Call step in, 27677 modified Check step in, 27475 preparation for, 284 protection from environment in, 283 sending for help in, 277 transporting person in, 27778 discussion, 315 disease process, 38 disease transmission, prevention of frequently asked questions about, 331 during training, 310 while giving care, 3839 dislocation, 163 in disaster, remote and wilderness emergencies, 280 of shoulder, 168 disposable gloves, 42 distress signal, 276 distributive shock, 143 dog bite. See Animal bite dressing, 155 drowning, 246, 252 care for, 25051 conscious and unconscious, 248 deprivation of oxygen and, 247 factors increasing likelihood of, 247 icy water and, 247 See also Water-related emergency drugs. See Poisoning, prevention of; Substance abuse and misuse E ear infection in children and infants, 258 ear injury, 18485 ecstasy. See Methylenedioxymethamphetamine (MDMA) ehrlichiosis, 214 elastic roller bandage, 155 elbow injury, 169 electrical burn, 162 electrolyte loss. See Dehydration embedded or impaled object, 157 in abdomen, 191 in cheek, 183 in chest, 190 in ear, 185 in eye, 184 EMD. See Emergency Medical Dispatcher emergencies responding to, 2429 types of, 25 emergency action steps. See Check-Call-Care Emergency Medical Dispatcher (EMD), 28, 30, 35 emergency medical services (EMS) system, 25, 28
emergency moves, 41, 251 emetic, 226 emphysema, 110 EMS. See Emergency medical services system enhanced 9-1-1, 35 epiglottitis, 112, 114 epilepsy, 199 epinephrine auto-injector, 209 exams. See Final written exams exercises, 7 extension, 45 external bleeding, 136, 13940 care for, 13638 in disaster, remote and wilderness emergencies, 280 frequently asked questions about, 337 in head, neck and spinal injury, 181 extremity injury immobilization of, 17273 lower, 17072 scenario for, 241 signals of serious, 167 upper, 16769 eye injury, 184 F fainting, 196, 340 falls and older adults, 261 false labor, 267 FAST (Face, Arm, Speech, Time), 200 febrile seizure, 258, 259 femur fracture, 170 fever in children and infants, 25859 fibula, 171 field exercise, 29293 final written exams administering Before Giving Care, 29495 administering CPR/AED, 29697 administering Responding to Emergencies: First Aid, 29899 administration of, 12 answer keys for AED component, A-13 Before Giving Care component, A-1, A-3 CPR component, A-5, A-7, A-9, A-11 Responding to Emergencies: First Aid component, A-15 questions and answer sheets for AEDAdult, Child or Infant, 38086 Before Giving Care, 34353 CPRAdult, 35459 CPRAdult, Child and Infant, 37279 CPRChild, 36065 CPRInfant, 36671 Responding to Emergencies: First Aid, 387401 finger injury, 169 first aid kit, 284 flexion, 45 fluid loss. See Dehydration food poisoning, 205 See also Poisoning foot injury, 172 forearm, wrist and hand injury, 169 foreign object. See Embedded or impaled object Fowlers position, 45 fracture, 163 in disaster, remote and wilderness emergencies, 280 of femur, 170 of rib, 189 of scapula, 168 frostbite, 234, 235
DRAFT
G gel pack, 338 genital injury, 19192 glucagon, 198 glucose tablet, 198 Good Samaritan laws, 27, 40, 33132 grades, 13 group activities, 31516 H hallucinogen, 223 hand injury, 169 head, neck and spinal injury(ies), 178, 187 care for, 18081 checking the scene in, 179 in disaster, remote and wilderness emergencies, 282 in older adults, 261 scenario for, 24041 signals of, 17980 specific, 18287 vomiting and, 339 water-related emergency and, 250 head splint technique, 250 Healthy Lifestyles Awareness Inventory, 22 hearing loss, 262 heart attack, 333 care for, 62 signals of, 6162 heat cramp, 23233 heat exhaustion, 233 heat-related illness(es), 230, 238 frequently asked questions about, 341 older adults and, 261 people susceptible to, 231 scenario for, 24243 specific, 23134 heat stroke, 23334 heat (thermal) burn, 161 hepatitis B, 310, 331 hepatitis C, 331 High Arm In Endangered Spine (H.A.IN.E.S.) position (modified), 51 for head, neck and spinal injury, 181 for seizure, 199 for stroke, 201 for sudden illness, 195 in water-related emergency, 251 HIV. See Human immunodeficiency virus hobo spider, 215, 216 human bite, 219 human body anatomy of, 45 importance of knowing anatomical terms of, 44 systems of, 46 temperature of, 23031 human immunodeficiency virus (HIV), 219, 331 humerus fracture, 168 hygiene, personal, 38 hyperglycemia, 197, 198, 340 hyperventilation, 111, 113 hypoglycemia, 197, 198, 340 hypothermia, 234, 23536 AED and, 83, 325 in older adults, 26162 hypovolemic shock, 143 I ice pack, 165, 338 icy water, 247, 252 illness childhood, 25660 mental, 263 in older adults, 26162 See also Heat-related illness(es); Sudden illness(es) impaled object. See Embedded or impaled object implantable device and AED, 83, 32526 infant(s) automated external defibrillator for, 9596, 9798, 99103, 1067, 325 cardiopulmonary resuscitation for, 7577, 7879, 1056 characteristics of, 254 checking conscious, 57 checking unconscious, 5354 common injuries and illnesses in, 25660 communicating with, 254 conscious choking in, 12123, 124, 336 observation of, 255 rescue breaths for unconscious, 50 signals of respiratory distress in, 11213 unconscious choking in, 13032, 13334, 337 infection, 38, 158 inhalant, 224 injury in children, 259 See also Musculoskeletal injury(ies); Soft tissue injury; individual injuries insect sting, 212 See also Bites and stings instructor materials for, 57, 313 responsibilities of, 23 scenario prompt guide for, 28991 teaching strategies for, 31419 Instructor Agreement and Code of Conduct, 3 instructor aide, 9 instructor, assisting, 9 Instructors Corner, 3, 67 insulin, 198 internal bleeding, 141, 338 care for, 142 signals of, 142 See also Closed wound; Shock International Association for Continuing Education and Training (IACET), 10 J jaw injury, 185, 186 jellyfish, 218 jewelry and AED, 83, 326 K knee injury, 171 L labor. See under Childbirth laceration, 15354 language barrier, 263 laxative, 226 lecture, 315 lecture points, 7 leg injury. See Extremity injury, lower lesson wrap-ups, 316 lifestyles, healthy, 2122 life-threatening conditions check for, 49 in head, neck and spinal injury, 181 lip injury, 185 lower back injury, 18687
Index 405
DRAFT
lower leg injury, 17172 Lyme disease, 21415 M manikin, 310 manual stabilization, 180 marijuana, 22425 marine life sting, 21718 materials, supplies and equipment, 47, 31213 medication. See Poisoning, prevention of; Substance abuse and misuse, prevention of mental illness, 263 mental impairment, 263 methamphetamine, 222 methylenedioxymethamphetamine (MDMA), 225 mini-stroke. See Transient ischemic attack (TIA) mobile phone. See Wireless phone mosquito bite. See West Nile virus (WNV) motor impairment, 26263 mouth, jaw and neck injury, 18586 moves. See Emergency moves multiple births, 271 muscle pull. See Strain musculoskeletal injury(ies), 160, 165, 174 care for, 16465 causes of, 163 frequently asked questions about, 339 immobilization of, 167 signals of, 164 types of, 163 See also Extremity injury; Head, neck and spinal injury musculoskeletal system, 160 N narcotic, 224 neck injury, 186 See also Head, neck and spinal injury(ies) neglect. See Child abuse and child neglect nitroglycerin, 333 nose injury, 183 O occlusive dressing, 155 older adults age-related changes in, 260 checking conscious, 5758 check of, 26061 common injuries and illnesses in, 26162 poisoning and, 204 open wound(s), 153, 158 care for, 15557 frequently asked questions about, 33839 types of, 15354 oral rehydration, 257 over-the-counter substance, 22526 Oxycodone, 224 P pacemakers and AED, 83, 32526 pack-strap carry, 41 parents, communicating with, 254 patella, 171 pathogens, bloodborne, 38 pediatrics. See Child(ren); Infant(s) pelvic cavity, 45 pelvic injury, 19192 personal protective equipment (PPE), 38 Poison Control Hotline, 204, 227 poisoning, 203, 210 anaphylaxis and, 2089
in children and infants, 260 frequently asked questions about, 341 general care for, 2034 prevention of, 210 types of, 2048 poisons absorbed, 2067 ingested, 2045 inhaled, 206 injected, 2078 precautions before giving care consent as, 39, 33132 Good Samaritan laws as, 40 prevention of disease transmission as, 3839 reaching and moving a person as, 4041 pregnancy, 266, 270 preschooler, 255 prone position, 45 psychedelics. See Hallucinogen puncture/penetration, 154 puncture wound, 190 R radiation burn, 163 rattlesnake, 217 reaching and moving a person, 4041 reaching assist, 249 recovery position, 51 See also High Arm In Endangered Spine (H.A.IN.E.S.) position (modified) recumbent position, 45 Red Cross Training Support Center, 13 refresher program, 4 rescue breaths, 50 rescues and assists, nonswimming, 249 respiratory distress and respiratory arrest, 108, 109 care for, 11314 conditions that cause, 11012 signals of, 11213 responder actions of, until help arrives, 3031 barriers to act and, 2627 decision to act by, 2526 emotions of, 330 incident stress of, 2829 role of, 25 See also Precautions before giving care Responding to Emergencies: Comprehensive First Aid/ CPR/AED course criteria for completion of, 11, 19 design of, 4 introduction to, 1820 length of, 8 modifications for, 10 organization of, 810 outline for, 1617 purpose of, 2 refreshers for, 4 video segments for, 32829 Responding to Emergencies: Comprehensive First Aid/ CPR/AED Course Presentation, 56 Responding to Emergencies: Comprehensive First Aid/ CPR/AED DVD, 6 Responding to Emergencies: Comprehensive First Aid/ CPR/AED Instructors Manual, 5 Responding to Emergencies: Comprehensive First Aid/ CPR/AED textbook, 4, 19 Reyes syndrome, 259 rib fracture, 189 RICE (rest, immobilize, cold and elevate), 16465
DRAFT
Rocky Mountain spotted fever, 213 roller bandage, 155 S Salmonella, 205 Sample Letter to course participants, 9 scalp injury, 182 scapula fracture, 168 scenarios for actions until help arrives, 3031 for AED for adult, 8790 for AED for child and infant, 100102 for childbirth, 26869 conducting of, 1112 for conscious person with breathing trouble, 14647 for conscious person with head, neck or spinal injury, 24041 for field exercise, 293 for heat-related illness, 237, 24243 for injury from fall, 288 instructions to students for, 146 instructor prompt guide for, 28991 for motorcycle accident, 3134 for substance abuse, 24344 for sudden illness, 242 for sudden illness with chest pain, 288 for unconscious adult with no signs of life, 148 for unconscious, breathing person, 147 for unconscious, breathing person with severe bleeding, 149 for unconscious, elderly person with no signs of life, 148 for unconscious person who vomited, 287 for unconscious person with injured extremity, 241 scenario worksheets Adult CPR, 3023 AED, 3078 Child CPR, 3035 First Aid, 3089 Infant CPR, 3056 school-age children, 255 scorpion sting, 21516 seizure, 19899 febrile, 258, 259 frequently asked questions about, 341 seniors. See Older adults shelter, 283 shock, 57, 14243, 338 in abdominal injury, 191 care for, 144 causes of, 143 in disaster, remote and wilderness emergencies, 281 in head or spinal injury, 181 signals of, 143 shoulder injury, 168 SIDS. See Sudden infant death syndrome Skill Charts and Skill Assessment Tools Applying a Manufactured Tourniquet, 140 Applying an Anatomic Splint, 175 Applying a Rigid Splint, 176 Applying a Sling and Binder, 177 Applying a Soft Splint, 17576 Checking Injured or Ill Adult (Appears to Be Unconscious), 52 Checking Injured or Ill Child or Infant (Appears to Be Unconscious), 5354 Conscious ChokingAdult and Child, 120 Conscious ChokingInfant, 124 Controlling External Bleeding, 139 CPRAdult, 6869, 9192 CPRChild, 7374 CPRInfant, 7879 Removing Disposable Gloves, 42 Unconscious ChokingAdult and Child, 12829 Unconscious ChokingInfant, 13334 Using an AEDAdult, 85, 9293 Using an AEDChild and Infant, 9798 skill posters, 6 skill sessions, 7, 31618 skills evaluations, 11 sling and binder, 177 snakebite. See Venomous snakebite soft tissue, 152 soft tissue injury, 152, 174 burns and, 16063, 165 closed wounds and, 15253 frequently asked questions about, 33839 infection and, 158 open wounds and, 15357 solvent, 224 special situations crime scenes and hostile situations and, 26364 language barriers and, 263 people with disabilities and, 262 spider bite, 21516 spinal cavity, 45 spinal injury. See Head, neck and spinal injury(ies) splint and splinting, 165, 17273, 17576, 339 for head in water-related emergency, 250 splinter, 157 sprain, 163, 280 stabilization. See Manual stabilization status epilepticus, 199 steroid. See Anabolic steroid stimulant, 22223 stitches, 156 stomachache. See Abdominal pain in children and infants strain, 163, 280 stroke, 200201, 34041 substance abuse and misuse, 22122, 228 care for, 227 prevention of, 22728 scenario for, 24344 signals of, 22627 types of substances and, 22226 sucking chest wound, 190 sudden illness(es), 194, 201 care for, 195 in disaster, remote and wilderness emergencies, 281 frequently asked questions about, 34041 scenarios for, 23944 signals of, 195 specific, 196201 See also Substance abuse and misuse sudden infant death syndrome (SIDS), 260 sun burn. See Radiation burn supine position, 45 syncope. See Fainting T test generator, 6 tetanus, 158, 218 textbook. See Responding to Emergencies: Comprehensive First Aid/CPR/AED textbook thermal (heat) burn, 161 thigh injury, 170 thoracic cavity, 45 throwing assist, 249 tibia, 171
Index
407
DRAFT
tick bite, 21213 ticks, diseases caused by, 21315 toddler, 255 tooth injury, 185 tourniquet, 137, 138, 140, 337 training equipment, 7 transdermal patch and AED, 83, 326 transient ischemic attack (TIA), 200 transportation of injured or ill person, 36, 27778 trauma, 188, 325 two-person lift, 251 two-person seat carry, 41 U umbilical cord, prolapsed, 271 unconscious person, 48, 51 check of, 5051 frequently asked questions about, 332 scenarios for, 14749, 241 Skill Charts and Assessments Tools for, 5254 upper arm injury, 168 upper extremity. See Extremity injury V venomous snakebite, 217 venous bleeding, 136 ventricular fibrillation (V-fib), 81, 322 ventricular tachycardia (V-tach), 81, 322 video segments, 32829 vision loss, 262 vomiting in children and infants, 257 head, neck or spinal injury and, 339 induced, 205 W wading assist, 249 walking assist, 41 water and AEDs, 326 water-related emergency, 24652 moving unresponsive person to dry land in, 251 nonswimming rescues and assists in, 249 person falling through ice in, 252 prevention of, 24748 recognizing, 248 taking action in, 249 See also Drowning West Nile virus (WNV), 215 wilderness emergency. See Disaster, remote and wilderness emergencies wireless phone 9-1-1 calls and, 35 automated external defibrillator and, 83 women, signals of heart attack in, 62 workplace certification, 10 wounds classification of, 152 puncture, 190 See also Closed wound; Open wound(s) wrist injury, 169
408
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DRAFT

Responding to Emergencies: Comprehensive First Aid/CPR/AED

David C. Berry, PhD, ATC, EMT-B

Andrew MacPherson, MD, CCFP-EM, FCFP

Jonathan L. Epstein, MEMS, NREMT-P

Jeffrey L. Pellegrino, Ph.D.

Andrew MacPherson, MD, CCFP-EM, FCFP

Joseph W. Rossano, MD, FACC, FAAP

The American Red Cross team for this edition included:

Michelle Jantz Paula Moore

Denise Gonzlez Hensal

Guidance and support were provided by the following individuals:

The StayWell team for this edition included:

Jennifer Surich Reed Klanderud

Responding to Emergencies: Comprehensive First Aid/CPR/AED

SECTION Appendix A: Appendix B:

Responding to Emergencies: Comprehensive First Aid/CPR/AED

Purpose of the Course

Responding to Emergencies: Comprehensive First Aid/CPR/AED

American Red Cross Resources

First Aid and CPR/AED Refreshers

Responding to Emergencies: Comprehensive First Aid/CPR/AED

American Red Cross Responding to Emergencies: Comprehensive First Aid/CPR/AED DVD

Additional resources on Instructors Corner:

Responding to Emergencies: Comprehensive First Aid/CPR/AED

Additional Resources for Instructors and Participants

Additional Red Cross Courses

SETTING UP AND RUNNING THIS COURSE

Responding to Emergencies: Comprehensive First Aid/CPR/AED

Health Precautions for Course Participants

Participants with Disabilities and Special Health Considerations

Setting Up and Running This Course

Course Modications for Different Settings

Training in the Workplace

Responding to Emergencies: Comprehensive First Aid/CPR/AED

CRITERIA FOR ASSESSING PARTICIPANTS

Criteria for Assessing Participants

Responding to Emergencies: Comprehensive First Aid/CPR/AED

Criteria for Grading Participants

Participant Course Evaluation

Criteria for Assessing Participants

Continuing Education Units for Professionals

Responding to Emergencies: Comprehensive First Aid/CPR/AED

MATERIALS, EQUIPMENT AND SUPPLIES

INTRODUCTION TO THE COURSE

PRESENTATION: INTRODUCTION TO THE COURSE

Responding to Emergencies: Comprehensive First Aid/CPR/AED

Responding to Emergencies: Comprehensive First Aid/CPR/AED

HEALTHY LIFESTYLES (OPTIONAL)

GUIDANCE FOR THE INSTRUCTOR

MATERIALS, EQUIPMENT AND SUPPLIES

EVALUATING YOUR LIFESTYLE

DISCUSSION PRESENTATION: EVALUATING YOUR LIFESTYLE

Healthy Lifestyles (OPTIONAL)

MAKING LIFESTYLE CHANGES

STRATEGIES FOR SUCCESSFUL BEHAVIOR CHANGES

DEVELOPING A BEHAVIOR MODIFICATION CONTRACT

Responding to Emergencies: Comprehensive First Aid/CPR/AED

Healthy Lifestyles (OPTIONAL)

IF NOT YOU . . . WHO?

GUIDANCE FOR THE INSTRUCTOR

MATERIALS, EQUIPMENT AND SUPPLIES