As a First Aider, you will sometimes encounter a patient with problems that are immediately life-threatening.

A patient may die within minutes unless he receives immediate treatment and transport to a hospital. Therefore, ASSESSMENT OF THE PATIENT would provide priorities of life-threatening conditions, treatment and/or immediate transport that would save or prolong the life of the patient. Following are the GUIDELINES in responding to an Emergency Condition: I. PLAN OF ACTION - To respond most efficiently to certain emergencies, you need a plan of action. Emergency plans should be established based on anticipated needs and available resources.

II.

GATHERING NEEDED MATERIALS the Emergency Response begins with the preparation of equipment and personnel before any emergency occurs.
REMEMBER the initial Response as follows: 1. A Ask for help. In a crisis, time is of essence. The more quickly you recognize an emergency, and the faster you call for Emergency Assistance, the sooner the victim will get help. Immediate care can greatly affect the outcome of an emergency. 2. I Intervene. It means to do something for the victim that will help achieve a positive outcome to an emergency.

III.

3. D DO NOT FURTHER HARM. Once you have begun First Aid, be sure you dont do anything that might worsen the victims condition. Certain actions should always be avoided and by keeping them in mind, you will be able to avoid adding to or worsening the victims illness or injuries. IV. INSTRUCTION TO HELPER/S. Remember that in providing care, you might need the assistance of the other personnel or a bystander. Proper information and instruction to a helper would provide organized First Aid Care.

EMERGENCY ACTION PRINCIPLES (EAP)

The following principles can ensure your safety and that of the victims and bystander/s. They will also increase the victims chance of survival if he has a serious illness or injury. I. SURVEY THE SCENE Once you recognized that an emergency has occurred and decided to act, you must make sure the scene of the emergency is SAFE for you, the victims and any bystanders. It is a quick assessment of the surroundings that will provide you with as much information as possible.

Take TIME to SURVEY the scene and answer these questions: * Is the scene SAFE? * What happened? * How many people are injured? * Are there bystanders who can help? * Then identify yourself as a Trained First Aider. * Get consent to give care. The following are ELEMENTS of surveying the scene for the First Aider to perform before providing care to a victim: 1. SCENE SAFETY. Look for possible threats for personal safety, patient and bystander. a. Patient Safety focus first on ensuring the well-being of the First Aider. You cannot help your patient if you become a victim yourself. In any emergency cases, exposure to communicable diseases are present.

In order to prevent any contamination, PROPER BODY SUBSTANCE ISOLATION decisions early in the emergency will prevent needless exposure later on. In situations of crime scene, acts of violence, and unsafe scene, you should consider asking appropriate personnel to secure the scene before providing care. But remember that they take time to arrive so, try to make the scene sa your capability permits. b. Patient/Victim If there are potential dangers that cannot be stabilized, you might need to perform special measures to offer additional protection to the patient. Like, removing the victim from hazardous environment, such as burning car, a home with a gas leak, etc.

c. Bystanders Safety of the onlookers or bystanders is also our concern. Bystanders can become a problem when they try to help or direct your care. Protect yourself and bystanders alike by moving them to a safe area or assigning them a specific task.
2. MECHANISM OF INJURY OR NATURE OF ILNESS Careful evaluation of the scene, including the possible mechanism of injury and/or the nature of illness, along with the other information that you gather will help determine the condition of the victim and what will be the next possible action of the First Aider. a. Mechanism of Injury is what caused the injury (ex.: a rapid deceleration causing the knees to strike the dash of the car, a fall causing a twisting force to the ankle)

Certain injuries are considered common to particular accident situations. Injuries to bones and joints are usually associated with falls and vehicular collisions; burns are common to fires and explosions; penetrating soft tissue injuries can be associated with gunshot wounds, and so on. b. Nature of Illness There are similarities between the mechanism of injury and the nature of illness. Both require you to search for clues regarding how the incident occurred. Nature of Illness is often best described by the patients chief complaint: the reason for providing care. In order to quickly determine the nature of the illness, talk with the patient, family, or bystanders about the problem. But at the same time, use your senses to check the scene for clues as to the possible problem.

3. DETERMINE THE NUMBER OF PATIENTS AND ADDITIONAL RESOURCES. As part of the survey the scene, it is essential that you accurately determine the total number of patients. This determination is critical for your estimate of the need for additional resources.
II. ACTIVATE MEDICAL ASSISTANCE (AMA) OR TRANSFER FACILITY In some emergencies , you will have time to call for specific medical advise before administering first aid. But in some situations, you will need to attend to the victim first. Decision in activating medical assistance or transfer facility would make a higher rate of survivability for the victim due to the continuing chain of survival in providing early defibrillation and ACLS.

1. Activate Medical Assistance or Transfer facility if: * The First Aider is alone, CALL FIRST, that is, activate medical assistance or arrange transfer facility before providing care for: > unconscious adult victim or child 8 years old or older, and > unconscious infant or child known to be at a high risk for heart problems. * The First Aider is alone, provide 1 minute of care, the CARE FAST for: > unconscious victim less than 8 years old; > any victim of submersion or near drowning; > any victim of arrest associated with trauma > any victim of drug overdose.

CALL FIRST should be assumed as cardiac emergencies such as, sudden cardiac arrest, and the time factor is critical.
CARE FAST the conditions are most often related to breathing emergencies rather than sudden cardiac arrest. Remember the most important initial assessment steps: (ABC) AIRWAY, BREATHING, CIRCULATION 2. Exceptions to the phone first/phone fast rule include: * * * * submersion/near drowning (phone fast; all ages) arrest associated with trauma (phone fast, all ages) drug overdoses (phone fast, all ages) cardiac arrest in children known to be at high risk for arrhythmias (phone first, all ages)

3. Information to be remembered in activating medical assistance. * * * * * What happened? Location Number of persons injured? Extent of injury or first aid given The telephone number from where you are calling. * Person who activated medical assistance must identify himself and drop the phone fast.

IV. DO A PRIMARY SURVEY OF THE VICTIM. In every emergency situation, you must first find out if there are conditions that are an immediate threat to the victims life. You will discover these conditions by looking for signs, evidence of injury or illness that you can observe. Check for vital body functions, signs of life-threatening conditions following the ABC principles.

STEPS in PERFORMING PRIMARY SURVEY

1. Check for Consciousness Begin primary survey by determining if the victim is conscious. A victim who can speak and move is conscious, breathing and with signs of circulation.

If the victim if found unconscious, try to confirm by checking his responsiveness by gently tapping him and asking, Are you okay? Do not jostle or move the patient. If the patient is unable to respond, he may be unconscious. *Unconsciousness can indicate a life-threatening condition. Regardless for the condition of the victim, do not forget to ask for consent.* 2. Check for A (Airway)

Ways in Opening the Airway

1. Head-tilt Chin-lift Maneuver Steps: a. With the patient in supine position, position yourself beside the patients head.

b. Place 1 hand on the patients forehead and apply firm backward pressure with your palm to tilt the patients head back. This extension of the neck will move the tongue forward, away from the back of the throat, and clear the airway if the tongue is blocking it. c. Place the tips of your fingers of your other hand under the lower jaw near the bony part of the chin. Do not compress the soft tissue under the chin, as this may block the airway. d. Lift the chin backward, bringing the entire lower jaw with it, and helping to tilt the head back. Do not use your thumb to life the chin. Lift so that the teeth are nearly brought together, but avoid closing the mouth completely. Continue to hold the forehead to maintain the backward tilt of the head.

Head-tilt Chin-lift Maneuver

2. Jaw-thrust Maneuver If you suspect a cervical spine injury, use the jawthrust maneuver. It is a technique to open the airway by placing the fingers behind the angle of the jaw and lifting the jaw upward. You can easily seal a mask around the mouth while doing the jaw-thrust maneuver. Steps: a. Kneel above the patients head. Place your fingers behind the angles of the lower jaw upward. Use your thumbs to help position the lower jaw to allow breathing through the mouth as well as the nose. b. The completed maneuver should open the airway with the mouth slightly open and jaw jutting forward.

Jaw-thrust Maneuver

3. Check B (Breathing) If victim is conscious, assess breathing by identifying the characteristics of his respiration (normal, shallow, labored, noisy). If unconscious, identify absent or inadequate breathing by performing Look, Listen and Feel : * Look for the rise and fall of the chest * Listen for air coming out from the nose and mouth * Feel for air touching your cheek 4. Check C (Circulation) Signs of circulation include: a. Pulse b. normal breathing c. coughing d. movement in response to rescue breaths

III. DO A SECONDARY SURVEY OF THE VICTIM Once you are certain that the victim has no lifethreatening conditions, you can begin the 4th EAP. Secondary survey is a systematic methods of gathering additional information about injuries or conditions that may need care. These conditions are not immediately life threatening but could become if not cared for. The following are in order, it will depend on the condition of the victim or situation of the accident: A. Interview the Victim By asking the victim and bystanders simple questions, you learn more about what happened and the victims condition: 1. Ask the victims name 2. Ask what happened 3. Ask the SAMPLE history

S Signs and symptoms of the episode A- Allergies, particularly to medications M Medications, including prescriptions, over-the-counter, recreational (illicit) drugs P Past medical history, particularly involving similar episode L Last oral intake, including food and drinks. This is important if the patient may need surgery. E Events leading up to episode.

B. Check the Vital Signs Vital signs can tell you how the body is responding to injury or illness. Note anything unusual. Recheck Vital signs every after 5 minutes for trauma, at least 15 minutes for each medical cases.

PULSE : It is the pressure wave generated by the

heartbeat. It directly reflects the rate, relative strength and rhythm of the contractions of the heart. Normal Ranges for Pulse Rate: Adult 60 90 beats/min Child 8 - 100 bpm Infant 100 120 bpm

RESPIRATION : consists of 1 inhalation and

1 respiration The normal number of respirations per minute varies with gender and age.

Normal Ranges Adult Child Infant -

for Respiration: 12 20 breaths per minute 18 25 bpm 25 35 bpm

SKIN APPEARANCE: assessment of the victims skin

temperature, color and condition can tell you more about the victims circulatory system.

1. Skin Temperature normal body temperature is 37 degree Celsius.

2. Skin color will tell you a lot about a patients heart, lungs and other problems. Ex: *Paleness shock or heart attack. May also be cause by fright, faintness or emotional distress as well as impaired blood flow * Redness (flushing) may be caused by high blood pressure, alcohol abuse, sunburn, heat stroke, fever or an infectious dse. * Blueness (cyanosis) always a serious problem. It appears first in the fingertips and around the mouth. Generally, reduced levels of oxygen as in shock, heart attack, or poisoning cause it. * Yellowish may be caused by liver disease * Black-and-blue (mottling) is the result of blood seeping under the skin, It is usually caused by a a blow or severe infection.

REDNESS (FLUSHING)

CYANOSIS

YELLOWISH

* If your patient has dark skin, be sure to check for color changes on the lips, nail beds, palms, earlobes, white of the eyes, inner surface of the lower eyelid, gums and tongue.* 3. Skin Condition Normally, a persons skin is dry to touch. When a patients skin condition is wet or moist, it may indicate shock, a heat-related emergency, or a diabetic emergency. Skin that is abnormally dry may be a sign of spine injury or severe dehydration.

PUPILS Normally, pupils constrict (get smaller) when

exposed to light and dilate (enlarge) when the level is reduced. Both pupils should be the same size unles a prior injury or condition changes this.

With the normal responses in mind, assess a patients pupils. Shine you penlight into one of the patients eyes and watch for the pupil to constrict in response to the light. If you are outdoors in bright light, cover the patients eyes and observe for dilation of the pupils. Do not expose the patients eyes to light for more than a few seconds, as this can be very uncomfortable to the patient. Abnormal findings for pupils include: * pupils do not react to light * pupils that remain constricted (this may be caused by a drug overdose) * pupils that are unequal (may indicate a serious head injury or stroke)

BLOOD PRESSURE

it is the amount of pressure the surging blood exerts against the arterial walls. It is an important index of the efficiency of the whole circulatory system. In part, it tells how well the organs and tissues are getting the oxygen they need. BP normally varies with gender, age and medical history of the patient:

*Adult male: (systolic) = 100 - 150 mmHg (diastolic)= 65 - 90 mmHg Both systolic and diastolic pressures are about 10mmHg lower in the females.

C. Do Head-to-toe Examination Use you senses when you do head-to-toe examination: sight, sound, smell and touch to detect anything normal. Look for DCAP-BTLS: D deformity C contusion A abrasion P puncture B burn T tenderness L laceration S swelling

GOLDEN RULES in giving EMERGENCY CARE

What to do: 1. Do obtain consent, when possible. 2. Do think the worst, its best to administer first for the gravest possibility. 3. Do remember to identify yourself to the victim. 4. Do provide comfort and emotional support. 5. Do respect the victims modesty and physical privacy. 6. Do be as calm and direct as possible. 7. Do care for the most serious injuries first. 8. Do assist the victim with his prescribed medication. 9. Do keep onlookers away from the injured person. 10. do handle the victim to a minimum. 11. Do loosen tight clothing.

What NOT to do: 1. Do not let the victim see his injury. 2. Do not leave the victim alone except to get help. 3. Do not assume that the victims obvious injuries are the only ones. 4. Do not make any unrealistic promises. 5. Do not trust the judgment of a confused victim and require the to make decisions.

GUIDELINES IN USING DRESSING AND BANDAGES

1. 2.

3.

4.

Use a dressing that is large enough to extend at least 1 inch beyond the edge of the edges of the wound. If body tissue or organs exposed, cover the wound with a dressing that will not stick, such as plastic wrap or moistened gauze. The secure the dressing with a bandage or adhesive tapes. If the bandage is over the joint, splint and make a bulky dressing so that the joint remains immobilized. If there is no movement of a wound over the joint, there should be improved healing and reduced scarring. A bandage should fit snugly but should not cut off circulation or cause the victim discomfort. If the area beyond the wound changes color, begins to tingle or feel cold, or if the wound starts to swell, the bandage is too tight and should be loosened.

5. Bandaging techniques depend upon: a. size and location of the wound b. your first aid skills c. materials at hand
1.

BANDAGING TECHNIQUES Triangular Bandage * Open Phase > Head (topside) > face; back of the head > Chest; back of chest > hand; foot * Cravat Phase > forehead; eye > ear; cheek; jaw > shoulder; hip > arm; leg > elbow; knee (straight; bent) > palm pressure bandage > palm bandage of open hand

SHOULDER BANDAGE (CRAVAT)

ELBOW BANDAGE (CRAVAT)

HAND BANDAGE (CRAVAT)

Back of the hand Palm of the hand

UPPER AND LOWER BANDAGE (CRAVAT)

KNEE BANDAGE (CRAVAT)

FOOT BANDAGE (CRAVAT)