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EMS Safety CPR/AED Training
Emergency Response for the Home, Community and Workplace
© 2012 EMS Safety Version B
INTRODUCTION
2CPR/AED for Community Rescuers
What we will learn today
• Quickly recognize an emergency• CPR on an adult victim• CPR on a child and infant victim*• AED use*• Emergency response
– Heart Attack– Stroke– Choking
*Optional Topic
3CPR/AED for Community Rescuers Intro
Certification Requirements
• Sign in on roster• Participate in all course activities • Pass written exam with 80% or more• Pass skills exams• Just FYI…
– Cards are valid for 2 years– Let me know privately if concerns about physical
requirements or any latex allergies– Participation certificates are available
4CPR/AED for Community Rescuers Intro
State & Local Requirements
• Guidelines are consistent with other nationally-recognized training organizations
• Follow state, local or workplace guidelines if they differ from this course
• Ask state or local Emergency Medical Services (EMS) Authority about– AED use on infants– Asthma inhalers– Epinephrine auto-injectors– Use of aspirin for heart attack signs and symptoms
5CPR/AED for Community Rescuers Intro
CHAIN OF SURVIVAL
6CPR/AED for Community Rescuers
Key Concepts
• Leading cause of death in U.S. is Heart Disease
• Heart disease leads to Sudden Cardiac Arrest (SCA)– Heart suddenly stops beating– Person is unresponsive– Breathing stops – Brain damage in 4 – 6 min w/o CPR
• The Chain of Survival is a series of actions that gives SCA victims the best chance of survival
7CPR/AED for Community Rescuers Chain of Survival
5 Steps to SCA Survival
What are the best actions to take immediately after Sudden Cardiac Arrest?
5 Steps to Survival
1. Activate EMS (Call 9-1-1)
2. Early CPR
3. Early Defibrillation
4. Early Advanced Care
5. Post-Arrest Care
8CPR/AED for Community Rescuers Chain of Survival
Activate EMS (Call 9-1-1)
Use cell phone or land line Activate EMS (Call 9-1-1)
• Recognize cardiac arrest– Not responding– Chest not moving, no
breathing
• Don’t delay: early 9-1-1 linked to increased SCA survival
• Send bystander if possible
• If unsure, go call!
9CPR/AED for Community Rescuers Chain of Survival
Early CPR
Start compressions! Early CPR
• Start with Chest Compressions
• Compressions restore flow of oxygen to brain
• Good chest compressions linked to increased survival
• Push hard and fast!
10CPR/AED for Community Rescuers Chain of Survival
Early Defibrillation
Early Defibrillation
• Defibrillators can restart the heart of an SCA victim
• Calling 9-1-1 gets a defibrillator to the scene
• An Automated External Defibrillator (AED) is used by citizen rescuers
• Some public places like airports have AEDs accessible to all rescuers
11CPR/AED for Community Rescuers Chain of Survival
Use AED when it arrives
Advanced & Post-Arrest Care
Advanced Care• AKA: Advanced Life
Support• Provided by paramedics,
continued at hospital• Adds advanced airway
management, drug therapy, cardiac monitoring to CPR
• Goal: restart heart and stabilize for post-arrest care
Post-Arrest Care• Comprehensive care once
person is stabilized• Begins at hospital and
continues through discharge
• Provided by doctors, nurses, therapists and many others
• Goal: Improve chances of continued survival with least disability
12CPR/AED for Community Rescuers Chain of Survival
Discussion
1. Why is activating EMS the first link in the chain of survival?
2. Are AEDs located in your community or workplace? Where?
3. Why does the bystander have the biggest impact on survival of SCA?
13CPR/AED for Community Rescuers Chain of Survival
CPR OVERVIEW
14CPR/AED for Community Rescuers
Key Concepts
CPR/AED for Community Rescuers CPR Overview 15
• Cardiac Arrest = – No heartbeat– No oxygen to brain or vital organs
• CPR can:– Keep brain alive– Oxygenate vital organs – Extend the time for successful defibrillation
Cardiopulmonary Resuscitation
Heart is squeezed between sternum and backbone
CPR
• Combines external chest compressions and rescue breathing
• Breaths fill lungs• Compressions move
oxygen by pumping blood• Keeps brain alive• Chest compressions
are most important part
CPR/AED for Community Rescuers CPR Overview 16
What is an AED
Automated External Defibrillator (AED) What it does…
• Uses voice and visual prompts
• Easily guides rescuers• Analyzes heart rhythm • Determines if shock is
needed• Restores normal rhythm• Provides CPR reminders
CPR/AED for Community Rescuers CPR Overview 17
Ventricular Fibrillation (V-fib)
V-fib to Shock to Normal V-fib is common in SCA
• Heart overwhelmed by electrical activity
• Can be related to lack of oxygen
• Quickly lethal• Victim unresponsive• CPR won’t stop V-fib• “Defib” is only treatment
for “V-fib”
CPR/AED for Community Rescuers CPR Overview 18
V-fib present in 90% of SCA cases
How an AED Works
• AED detects V-fib• Sends powerful
current through heart• Shock resets heart’s
electrical activity• Heart may start
beating normally• Like a ‘control-alt-
delete’ for the heart
CPR/AED for Community Rescuers CPR Overview 19
Power on & attach pads
Sum it Up
• CPR restores flow of oxygen to the brain• CPR can extend time for successful AED use• The sooner an AED is used, the more likely it will
work
CPR/AED for Community Rescuers CPR Overview 20
C-A-B
The C-A-B sequence applies to victims of all ages. Learn the adult sequence first…
CPR/AED for Community Rescuers 21
Key Concepts
• C-A-B stands for: – Compression – Airway– Breathing
• Best sequence of rescuer actions for CPR– In first few minutes victim’s body still has oxygen-rich
blood– Starting with chest compressions circulates oxygen,
eliminating need to start with rescue breaths
• The C-A-B sequence is used for unresponsive victims of all ages
CPR/AED for Community Rescuers C-A-B 22
Establish Response, Check Breathing
Hey! Are you okay? Tap and shout
• If no response– Go call 9-1-1– Get an AED if available– Send bystander if present
Scan the chest for breathing, 5-10 seconds• If no breathing or only
gasping:
START COMPRESSIONS
CPR/AED for Community Rescuers C-A-B 23
C: Compressions
Push Hard & Fast! Provide 30 Compressions
• Use a firm, flat surface• Center of the chest,
between nipples• Push hard: At least 2”• Push fast: At least 100
compressions per minute• Ensure full recoil: Chest
expands between each compression
• Minimize interruptions
CPR/AED for Community Rescuers C-A-B 24
A: Airway
Prepare for rescue breaths Quickly Open Airway
• Position head using the head tilt/chin lift
• Place 1 hand on forehead• Place 2 or 3 fingers of
your other hand near the chin
• Tilt the head back while lifting the jaw upward
CPR/AED for Community Rescuers C-A-B 25
B: Breathing
Give breaths carefully… 2 Rescue Breaths
• About 1 second per breath• Maintain head tilt/chin lift• Pinch nose• Seal the victim’s mouth with
yours or use barrier• Breathe into the mouth for
about 1 second• Watch for chest rise• Lift mouth off• Repeat for 2nd breath
CPR/AED for Community Rescuers C-A-B 26
Too much air causes vomiting
Repeat the C-A-B Sequence
• Take < 10 seconds to give 2 breaths• Quickly resume chest compressions after giving
rescue breaths• Continue repeating the sequence of 30
compressions, open airway, give 2 breaths• CPR is performed in cycles
– 1 cycle is 30 compressions and 2 breaths (30:2)– 5 cycles of CPR can be performed in about 2 minutes
CPR/AED for Community Rescuers C-A-B 27
When to Use the AED
Use AED when it’s available If 2nd Rescuer Present
• Rescuer 1 continues CPR• Rescuer 2 operates AED• Switch roles when the AED
prompts to stop CPR– If no AED, switch performing
CPR about every 2 minutes
• Observe CPR provider & give feedback
• Pushing hard/fast enough?
CPR/AED for Community Rescuers C-A-B 28
Recovery Position
If breathing normally…Modified H.A.IN.E.S Recovery Position
• Use when – Need to leave to get
help– Victim vomits
CPR/AED for Community Rescuers C-A-B 29
Place victim on side
Discussion
• Could I really do it?
CPR/AED for Community Rescuers C-A-B 30
Sum It Up
• Starting CPR with chest compressions circulates the oxygen still in the blood and gives the victim the best chance of survival
• Quality compressions matter• Push hard and fast• Minimize interruptions to compressions
– No more than 10 seconds to give breaths
• Allow the chest to fully recoil (expand) between each compression– Take your weight off the victim’s chest
CPR/AED for Community Rescuers C-A-B 31
CPR BARRIERS
CPR/AED for Community Rescuers 32
Key Concepts
• The risk of catching a disease with rescue breaths is extremely low
• It is common to be uncomfortable with the thought of giving mouth-to-mouth rescue breaths
• CPR barriers can help prevent exposure to blood or body fluids
• Create a barrier between the victim and rescuer while allowing for the passage of air
CPR/AED for Community Rescuers CPR Barriers 33
CPR Face Mask
• May require quick assembly
• Covers mouth and nose• Prevents back flow of
exhaled air or fluids• Select the correct size:
– Base (wide end) does not extend past chin
– Top (narrow end) does not extend past bridge of the nose
CPR/AED for Community Rescuers CPR Barriers 34
Molded plastic mask
Using a Face Mask
1. Press mask onto face
2. Lift the chin to open the airway
3. Breathe into the mask
4. Watch for chest rise with each breath
CPR/AED for Community Rescuers CPR Barriers 35
CPR Face Shield
• Fits over the mouth• Pinch the nose over
or under the face shield
• Stored in keychain pouch with gloves
• Close to rescuer at all times
CPR/AED for Community Rescuers CPR Barriers 36
Small, flexible plastic with a filter or valve
Using a CPR Face Shield
1. Place over face with filter or valve over person’s mouth
2. Open airway
3. Pinch nose
4. Breathe into the filter or valve
5. Watch for chest rise with each breath
CPR/AED for Community Rescuers CPR Barriers 37
USING AN AEDOptional Segment, only required for AED certification…
CPR/AED for Community Rescuers 38
Optional Topic
Key Concepts
• AEDs can be used on adults, children and infants
• An AED has a status indicator to show if it is ready for use
• Follow local protocols for age-specific AED guidelines if they differ from this course
• Basic AED Sequence:– Power on the AED– Apply pads– Follow AED prompts
CPR/AED for Community Rescuers Using an AED 39
Power the AED
• Place AED near head• Power on AED• AED guides actions
CPR/AED for Community Rescuers Using an AED 40
Apply AED Pads
• Expose chest– Cut clothing– Wipe dry
• Apply pads (follow pictures)– Right upper chest, just
below collarbone– Lower left side of the
chest
• If 2 rescuers– Rescuer 1 continues
CPR– Rescuer 2 operates
AEDCPR/AED for Community Rescuers Using an AED 41
Shock or No Shock?
• After pads are applied:– AED prompts rescuer to stop CPR– AED analyzes the heart’s electrical rhythm– Do not touch or move the person
• AED will state ‘shock advised’ or ‘no shock advised’
• If no shock advised, AED will prompt rescuer to resume chest compressions
• If shock advised, rescuer must clear victim first
CPR/AED for Community Rescuers Using an AED 42
Clear Victim and Shock
• Clear victim first– Loudly state, “Clear!”– Look up and down entire
victim– Ensure no one touching
person or clothing
• Press shock button– Some AEDs shock
automatically (no button)– AEDs announce when
safe to resume compressions
CPR/AED for Community Rescuers Using an AED 43
Do not touch victim or clothing during a shock
Resume CPR
• Start with chest compressions
• AED will analyze heart rhythm every 2 minutes
• If 2nd rescuer present– Switch roles when AED
prompts to stop CPR– One rescuer rests– Other rescuer gets in
position for CPR– Rescuer 2 will continue
to operate AED
CPR/AED for Community Rescuers Using an AED 44
Immediately resume CPR
AED Use on Children
• Children & infants require less electrical current
• Special equipment reduces amount of energy delivered– Child/Infant Pads– Energy reducer or
attenuator– Pediatric key or switch
• If pediatric equipment is not available, use standard equipmentCPR/AED for Community Rescuers Using an AED 45
For AED use:A child is 1-8 years old, or less than 55 lbs.An infant is < 1 year old
For Smaller Children or Infants
CPR/AED for Community Rescuers Using an AED 46
• Use front-to-back AED pad placement if needed
• Pads should not touch or overlap• Do not cut or fold pads to fit
ADULT CPR
In CPR, a victim is considered an adult when signs of puberty are present. Look for facial or underarm hair on a male or signs of breast development on a female.
CPR/AED for Community Rescuers 47
Key Concepts
• Always check the scene for safety first• If the scene is safe, establish a response• If unresponsive and not breathing or only
gasping, provide CPR using the C-A-B sequence
CPR/AED for Community Rescuers Adult CPR 48
Starting CPR
• Survey scene, size-up potential hazards
• Tap the shoulder and shout, “Are you all right?”
• Call 9-1-1, get AED– Send bystander– Go yourself if alone
• Scan chest for breathing (5-10 seconds)
• Start compressions if no breathing, only gasping, unsure if breathing
CPR/AED for Community Rescuers Adult CPR 49
C: 30 Compressions
• Expose chest if needed• Location: center of the
chest, between nipples• Use 2 hands:
– Heel of one hand on chest– Heel of other hand on top
• Push hard: At least 2” down• Push fast: At least 100 per
minute• Ensure full recoil• Minimize interruptions
CPR/AED for Community Rescuers Adult CPR 50
Use a firm, flat surface
A: Open Airway
• Place 1 hand on the forehead – Apply firm, backward
pressure with your palm– Tilt head back
• Place 2 or 3 fingers of other hand near chin – Keep fingers on bony
part of the jaw
• Tilt the head back, lift the chin forward
CPR/AED for Community Rescuers Adult CPR 51
B: Give 2 Breaths
• Maintain head tilt/chin lift
• Pinch the nose• Breathe into mouth
for about 1 second• Watch for chest rise• Repeat for the 2nd
breath• Do not over-ventilate
CPR/AED for Community Rescuers Adult CPR 52
Continue CPR
• If 2 rescuers, switch roles every 2 min (5 cycles) or when AED is analyzing– Rest between roles as CPR
provider– Keep provider on pace (at
least 100 comp/min)– Instruct compressor to push
harder (at least 2”) if too shallow
• Only Stop CPR if– Victim begins to move– EMS responders take over– AED prompts you to stop
CPR/AED for Community Rescuers Adult CPR 53
Cycles of 30:2
Defibrillation
• Use when available• Place near victim’s
head• Power on AED• Follow prompts• Apply pads• Press shock button• Resume compressions
after shock
CPR/AED for Community Rescuers Adult CPR 54
Discussion
1. What is the best way to activate EMS at home? At work?
2. What do you do if the chest won’t rise with the 1st rescue breath?
3. What is the most important part of CPR: compressions, airway management, or rescue breathing?
CPR/AED for Community Rescuers Adult CPR 55
CHILD CPR In CPR, a victim is considered a child from age 1 until puberty.
CPR/AED for Community Rescuers 56
Key Concepts
• Usually different cause of cardiac arrest for children and infants than for adults– Adults: Heart disease, heart attack– Children/infants: Respiratory arrest
• Common causes of respiratory arrest in children:– Injury– Poisoning– Choking– Drowning– Asthma
CPR/AED for Community Rescuers Child CPR 57
Starting CPR
• Survey scene, size-up potential hazards
• Tap the shoulder and shout, “Are you all right?”
• Send bystander to call 9-1-1, get AED
• Stay with the child• Scan the chest for
breathing, 5-10 seconds• Start compressions if no
breathing, only gasping, if you’re unsure
CPR/AED for Community Rescuers Child CPR 58
If alone, yell for help. Stay for 2 minutes of CPR before leaving to call 9-1-1
C: 30 Compressions
• Expose chest if needed• Location: Center of the
chest, between nipples• Use 1 or 2 hands• Push hard: About 2”
down• Push fast: At least 100
per minute• Ensure full recoil• Minimize interruptions
CPR/AED for Community Rescuers Child CPR 59
Use a firm, flat surface
A: Open Airway
• Place 1 hand on the forehead – Apply firm, backward
pressure with your palm
– Tilt head back• Place 2 or 3 fingers
of other hand near chin – Keep fingers on bony
part of the jaw• Tilt the head back,
lift the chin forwardCPR/AED for Community Rescuers Child CPR 60
B: Give 2 Breaths
• Maintain head tilt/chin lift
• Pinch the nose• Breathe into mouth
for about 1 second• Watch for chest rise• Repeat for the 2nd
breath• Do not over-ventilate
CPR/AED for Community Rescuers Child CPR 61
Continue CPR
• If 2 rescuers, switch roles every 2 minutes (5 cycles)– Rest between roles
as CPR provider– Keep provider on
pace (at least 100/min)
– Instruct compressor to push harder if too shallow
CPR/AED for Community Rescuers Child CPR 62
Cycles of 30:2
Call 9-1-1
• Return quickly• Resume CPR until
EMS takes over or the child begins to move
• Use an AED as soon as it is available
CPR/AED for Community Rescuers Child CPR 63
If still alone after 2 minutes, go activate EMS and get an AED if one is close by
INFANT CPR In CPR, a victim is considered an infant up to1 year old.
CPR/AED for Community Rescuers 64
Key Concepts
• Common causes of respiratory arrest in infants:– Choking– Injury – Sudden Infant Death Syndrome (SIDS)– Respiratory illness
CPR/AED for Community Rescuers Infant CPR 65
Starting CPR
• Survey scene, size-up potential hazards
• Tap bottom of foot and shout
• Send bystander to call 9-1-1, get AED
• Scan the chest for breathing, 5-10 seconds
• Start compressions if no breathing, only gasping, or if you’re unsure
CPR/AED for Community Rescuers Infant CPR 66
If alone, yell for help. Stay for 2 minutes of CPR before leaving to call 9-1-1
C: 30 Compressions
• Expose chest if needed• Location: Center of chest,
just below nipple line• Use 2 fingers• Push hard: About 1½”
down• Push fast: At least 100
per minute• Ensure full recoil• Minimize interruptions
CPR/AED for Community Rescuers Infant CPR 67
Use a firm, flat surface
A: Open Airway
• Place 1 hand on the forehead – Apply firm, backward
pressure with your palm– Tilt head back
• Place 2 or 3 fingers of other hand near chin
• Tilt the head back, lift the chin forward
• Maintain a neutral or slightly extended position
CPR/AED for Community Rescuers Infant CPR 68
Do not tilt the head too far back. Overextending the airway can actually close it!
B: Give 2 Breaths
• Maintain head tilt/chin lift
• Breathe into mouth and nose about 1 second
• Watch for chest rise• Repeat for the 2nd
breath• Do not over-ventilate
CPR/AED for Community Rescuers Infant CPR 69
Breathe into mouth and nose at the same time
Continue CPR
• If 2 rescuers, switch roles every 2 minutes (5 cycles)– Rest between roles as
CPR provider– Keep provider on pace
(at least100/min)– Instruct compressor to
push harder if too shallow
CPR/AED for Community Rescuers Infant CPR 70
Cycles of 30:2
Call 9-1-1
• Take the infant with you if you have to leave
• Resume CPR until EMS takes over or the infant begins to move
• Use an AED as soon as it is available
CPR/AED for Community Rescuers Infant CPR 71
If still alone after 2 minutes, call 9-1-1
SPECIAL CONSIDERATIONS - CPR
CPR/AED for Community Rescuers 72
Key Concepts
• Certain situations may affect response to cardiac arrest
• Keep CPR going as long as possible• In cold environments
– A hypothermic victim may have more time before brain damage occurs
– Do not assume it is too late to begin CPR
• Electrical shock may cause immediate respiratory or cardiac arrest– Scene safety is most important– Shut off the power source first
• Make sure scene is safe before approaching victim
CPR/AED for Community Rescuers Special Considerations - CPR 73
Vomiting
• A person in cardiac arrest will often vomit from over-ventilation
• If the victim vomits, roll person to side, sweep out mouth, roll back, continue CPR
• Reduce risk with rescue breaths by providing just enough air to cause the chest to rise
CPR/AED for Community Rescuers Special Considerations - CPR 74
When to Stop CPR
• Victim begins to move or breathe
• AED directs you to stop• Scene becomes unsafe• Physically exhausted and
unable to continue• Professional rescuers
arrive and are ready to take over
• Victim is pronounced dead by a qualified person
CPR/AED for Community Rescuers Special Considerations - CPR 75
Compression-only CPR
• Continuous chest compressions without rescue breaths
• Exchange of oxygen occurs with the force of compressions
• Taught by dispatchers to untrained rescuers who call 9-1-1
• Also used for adult victim if rescuer is unable or unwilling to provide rescue breaths
CPR/AED for Community Rescuers Special Considerations - CPR 76
Only for adult victims
Nose and Stoma Rescue Breathing
Mouth-to-Nose
• Use if victim’s mouth or jaw is severely damaged
• Holding mouth closed prevents air from escaping
• Make a seal and exhale into victim’s nose
Mask-to-Stoma
• Stoma: surgical opening at base of throat
• Can be performed with mask or mouth-to-stoma
• Pinch nose closed if possible to prevent air escape
• Make a seal around the stoma and exhale; watch for chest rise
CPR/AED for Community Rescuers Special Considerations - CPR 77
SPECIAL CONSIDERATIONS - AED
Optional segment, only required for AED certification
78
Optional Topic
Key Concepts
• There are 3 situations to consider when applying AED pads that may alter rescuer’s actions: – A very hairy chest– An implanted device (e.g. pacemaker)– A medication patch
CPR/AED for Community Rescuers Special Considerations - AED 79
Very Hairy Chest
• A lot of chest hair limits contact between AED pad and victim’s skin
• AED may not be able to read heart rhythm
• If the first set of pads is not working– Press pads firmly onto
skin– Remove with a quick
motion– Apply second set of pads
CPR/AED for Community Rescuers Special Considerations - AED 80
If only 1 set of pads is available, quickly shave the areas of pad placement before applying pads
Implanted Devices
• Devices may include− Pacemaker− Automated Implantable
Cardioverter-Defibrillator (AICD)
− Medication administration port
• Most implanted devices do not affect AED pad placement.– Do not place pad directly
over implanted device– Adjust pad placement at
least 1” from device
CPR/AED for Community Rescuers Special Considerations - AED 81
Device may appear as a small raised lump under skin
Medication Patches
• Do not place an AED pad over a medication patch– Use a gloved hand to
remove the patch– Quickly wipe chest
clean with a towel or cloth
• Apply pads after area is wiped clean
CPR/AED for Community Rescuers Special Considerations - AED 82
Medication can be embedded in an adhesive patch applied to skin
Storage & Maintenance
• Close to trained rescuers– Near most of people, most of the
time– Visible signage; easy access– Common areas easy to describe
• With accessories– Spare adult pads– Pediatric pads or adaptor– CPR barrier, gloves– Safety razor– Absorbent towel
• Inspection– Status indicator shows ‘Ready’– Pads & battery not expired– No visible damage– No missing accessoriesCPR/AED for Community Rescuers Special Considerations - AED 83
Troubleshooting
• An AED performs self checks regularly and every time it is powered on.
• The AED will notify operator if problem detected• “Check pads”
– Press down firmly, or replace pads w/ back up set– Check pad connection to AED
• “Low Battery”– Replace battery– Even in low battery state, AED may provide several shocks– Refer to AED manufacturer for more information
• Movement– Disrupts analysis of heart rhythm– When AED is analyzing, do not touch or move victim
CPR/AED for Community Rescuers Special Considerations - AED 84
Sum It Up
• Consider shaving a very hairy chest before pad placement
• Avoid placing pads over implanted device• Remove medication patches• Store AED near trained rescuers and a phone• If a problem with AED cannot be quickly solved,
discontinue AED use and resume CPR
CPR/AED for Community Rescuers Special Considerations - AED 85
AED SAFETYOptional segment, only required for AED certification
86
Optional Topic
Key Concepts
• Using an AED during an emergency is safe
• Take precautions to maximize safety• Consider rescuer’s actions when:
– Clearing the victim– Water is present– The victim is using oxygen
CPR/AED for Community Rescuers AED Safety 87
What is Wrong With This Picture?
CPR/AED for Community Rescuers AED Safety 88
Water
• If victim is lying in puddle of water– Move to a dryer area– Ensure rescuers not standing
in water
• Water on victim’s chest can interfere with defibrillation– Quickly dry chest before
applying pads– A wet chest may cause
electricity from AED to disperse before reaching heart
• Good pad contact with dry skin provides more effective and directed shock to heart
CPR/AED for Community Rescuers AED Safety 89
How would you make this scene safe for AED use?
Wipe chest dry before applying pads
Oxygen
• Medical oxygen is combustible
• If a person is wearing oxygen– Turn it off or remove the
mask or cannula
• If oxygen is being used with rescue breaths – Move it several feet from
victim before shock– Resume rescue breaths
with supplemental oxygen
CPR/AED for Community Rescuers AED Safety 90
Some people may use oxygen at home or out in community
Discussion: How would you REACT?
• Instructor-led discussion• Review workbook questions• Discuss at least 1 scenario
CPR/AED for Community Rescuers REACT Discussion 91
RESPONDING TO EMERGENCIES
CPR/AED for Community Rescuers 92
Key Concepts
• Emergency scenes can be dangerous• Rescuers can quickly become victims• Caution and common sense can save your life
CPR/AED for Community Rescuers Responding to Emergencies 93
R.E.A.C.T to an Emergency
• R: Recognize Emergency• E: Environment Safety and Size-Up• A: Assess Victim• C: Call for Help• T: Treat Victim
CPR/AED for Community Rescuers Responding to Emergencies 94
Recognize Emergency
• Screams, panic; seriously ill or injured person; victim or bystanders agitated or threatening
• Suspicious environment; collision or stopped vehicle; environmental hazard
• Remain calm; stay aware of your own safety
• Consider resources and options
CPR/AED for Community Rescuers Responding to Emergencies 95
Environment Safety
• Size-up the scene from a safe distance– Blood and body fluids: Use personal protective equipment– Traffic: Use car to protect scene; use bystanders to stop traffic– Fire or smoke: Do not enter; focus on escape; stay low– Hazardous chemicals: Leave the area immediately– Confined space: Do not enter! – Hostile environment: Do victim or bystanders appear agitated or
threatening? • Size-up the victim
– How many? – What is their general condition?– Identify cause of illness or injury– If more than 1 victim, decide who needs help most. If unsure,
help person closest to you. • Activate EMS now if the scene is dangerous or if there is
an obvious life-threatening injury or illness.
CPR/AED for Community Rescuers Responding to Emergencies 96
Assess Victim & Call for Help
CPR/AED for Community Rescuers Responding to Emergencies 97
• Assess the victim– Go to the victim’s side – Assess response and
breathing – Life-threatening illness or
injury
• Call for help– Shout for help– Call 9-1-1 or your emergency
response #
• If not sure it’s an emergency?– Activate EMS – Dispatcher will ask questions
to determine if an emergency
Treat Victim
• Treat life-threatening conditions first– If no breathing or only
gasping, begin CPR– If severe bleeding, control
with direct pressure
• Treat victim in position found
• Only move victim if– Danger– Need to position for
essential care
CPR/AED for Community Rescuers Responding to Emergencies 98
Calling 9-1-1
• When you call 9-1-1, dispatcher will ask– Name, location, call back phone #– What happened– Number of victims and general condition – What aid is being given
• Follow instructions, and always hang up last• When EMS responders arrive
– Continue care until told to stop– Tell EMS what time event occurred, what time you
arrived, and what care has been given
CPR/AED for Community Rescuers Responding to Emergencies 99
Rescuer Stress
• Normal to feel stress after incident
• Each rescuer responds differently to stress
• Don’t ignore post-traumatic stress, manage it– Talk about your feelings– Eat properly– Avoid alcohol, drugs, caffeine– Exercise– Get enough rest
• Don’t judge yourself for your actions
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Obtain professional help if needed
LEGAL ISSUES
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Key Concepts
• Some people have a duty to respond to an emergency
• Other people respond voluntarily• Voluntary responders are protected by the Good
Samaritan Law• Maintain skills to stay informed on current
practices
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Good Samaritan Law
• Respond voluntarily• Not getting paid to
respond• Provide care with good
intentions• Stay within limits of
training• Not reckless or careless• Do not abandon victim
after beginning care
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Protects voluntary responders from civil liability
Gaining Consent
• State name, training, & care plan• Ask if you can help• Types of Consent
– Expressed: expresses desire for aid– Implied: unresponsive person,
unattended minor– Minor’s consent: A parent or legal
guardian gives consent
• Right to Refuse Care– Can refuse care at any time– Observe situation from a distance,
call 9-1-1 if needed
• Right to Privacy– Do not give out information to
coworkers or bystanders– Give information to EMS responders
and to supervisor
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Get consent from victim before beginning care
PROTECTION FROM INFECTION
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Key Concepts
• The OSHA Bloodborne Pathogens Standard requires the employer to help protect you from exposure to BBP
• Use precautions with every emergency• Hand washing is an important part of infection
control
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Bloodborne Pathogens
• Most serious: – HIV – Hepatitis B – Hepatitis C
• May be transmitted during an emergency when – Giving first aid – Handling contaminated
sharps– Cleaning a blood spill
• Routes of transmission– Splash to eye, mouth or nose– Opening in skin (cut, scab,
rash, hangnail)
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Bloodborne pathogens are disease-causing microorganisms in blood
Universal Precautions
• Assume all blood and body fluids are infectious, except sweat
• Take precautions with all victims, even children
• Use personal protective equipment– Disposable gloves– Gown– Mask, goggles or face mask – CPR barrier
• Wash hands thoroughly immediately after glove removal
• If no water, use hand sanitizer, then wash ASAP
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What To Do If You’re Exposed
Follow Exposure Control Plan Hand Washing Technique
• Wash hands and any exposed area as soon as possible
• Use soap and warm water
• Scrub thoroughly for at least 20 seconds
• Rinse well
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• Immediately remove gloves• Wash thoroughly with soap
and water
Removing Soiled Gloves
1. Pinch base of glove, peel off slowly, hold in other hand
2. Slip 1 or 2 fingers inside other glove, carefully peel off so that it is inside out
3. Dispose in proper, leak-proof container
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Cleaning After an Emergency
• Clean spill with paper towels or an absorbent powder
• Pick up sharp objects or broken glass with tongs or brush and dustpan
• Disinfect with 10% bleach and water or another disinfectant
• Dispose of soiled personal protective equipment according to workplace policy
• Wash your hands
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Wear personal protective equipment
Airborne Pathogens
• Other diseases can be spread when an ill person coughs or sneezes
• Protect yourself by:– Getting a flu vaccine– Washing your hands often– Avoiding contact when possible with people who may
be contagious
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Sum it Up
• Keep first aid kits stocked with personal protective equipment
• If you don’t have personal protective equipment with you, use whatever is available:– e.g. To control bleeding, have the victim apply the
pressure, or use layers of clean cloth or extra gauze
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HEART ATTACK
CPR/AED for Community Rescuers 114
Key Concepts
• Heart disease is leading cause of death in the U.S.
• Heart attack can lead to cardiac arrest• More than 1.25 million Americans have a first or
recurrent heart attack every year• About 70% of the deaths from heart attack occur
before the victim reaches the hospital• Call 9-1-1 early for any signs of heart attack
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What is a Heart Attack?
• Coronary Artery Disease– Build-up of fatty deposits in
blood vessels– Coronary arteries narrow &
harden over years– Vessels become blocked– CAD is preventable
• What is a heart attack?– Heart pumps blood throughout
the body– Coronary arteries deliver
oxygenated blood to heart– A blocked coronary artery
deprives the heart of oxygen– Results in death of heart
muscleCPR/AED for Community Rescuers Heart Attack 116
Heart Attack Signs & Symptoms
• Chest discomfort– Pain, pressure, tightness, squeezing, fullness– Discomfort may radiate to the arms, neck, back, jaw,
or abdomen– Often mistaken for heartburn or indigestion
• Pale, cool, sweaty skin• Shortness of breath• Dizziness, fainting or unresponsiveness• Nausea, vomiting• Unexplained fatigue
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Emergency Care for Heart Attack
1. Call 9-1-1, get AED if available
2. Position of comfort, usually sitting
3. Calm, reassure person
4. Offer 1 adult or 2 baby aspirin for victim to chewa. No allergy to aspirin, signs of stroke, or recent
bleeding problems
b. Make sure victim is alert and can swallow
5. Check breathing if victim becomes unresponsivea. If no breathing or only gasping, begin compressions
b. Use the AED when it arrives
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Don’t Delay Calling 9-1-1
• If any signs and symptoms are present• If the symptoms fade and return• To give aspirin• Calling 9-1-1 can mean difference between heart
attack & cardiac arrest• Professional Rescuers can provide treatment
before cardiac arrest occurs
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Unusual Symptoms
• Be alert to other symptoms– Extreme fatigue– Nausea, vomiting– Shortness of breath– Pain in jaw, neck, arm(s)
or abdomen
• Women are as likely to have a heart attack as men
• May not report symptoms• Often misdiagnosed
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Women, diabetics, elderly may not have classic ‘chest discomfort’
Use of Aspirin
• Chewing aspirin gets it into the bloodstream faster than swallowing it
• Aspirin thins blood, reduces ability to clot
• Ensure no allergy to aspirin, signs of stroke, or recent bleeding problems
• Victim must be alert and able to swallow
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Learn your state, local & workplace guidelines for use of aspirin.
Offer 1 adult or 2 baby aspirin for victim to chew
STROKE
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Key Concepts
• Stroke is 3rd leading cause of death in U.S.• 800,000 strokes each year in the U.S.• Call 9-1-1 early for any signs of stroke
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What is a stroke?
• A stroke is like a heart attack occurring in the brain
• Caused by a clot or bleed in the brain• Symptoms may be minor or severe• Many survivors are permanently impaired
and struggle with daily activities
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Stroke Signs & Symptoms
• Sudden onset• Weakness or numbness of arm or leg, usually on
one side of body• Facial droop or paralysis• Difficulty speaking• Difficulty eating, swallowing, or managing secretions• Loss of balance or coordination, difficulty walking• Confusion, anxiety, unresponsiveness• Changes in sensation• Severe headache or dizziness• Change in vision• Temporary symptoms may be a baby stroke
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Emergency Care for Stroke
1. Call 9-1-1 (activate EMS)
2. Protect the airwaya. Place in the recovery position to allow fluids to drain
if needed
3. Calm and reassure victim
4. Note time that symptoms began
5. If person is unresponsivea. Check for breathing
b. Start compressions if needed
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Don’t Delay Calling 9-1-1
• Call 9-1-1 immediately for signs of stroke• Do not wait to see if symptoms go away• Do not drive to hospital• The time it takes to call 9-1-1 is critical
– Some strokes treated with clot-busting medication (fibrinolytic therapy)
– Same as with a heart attack– Only effective in the first few hours of a stroke
• Early recognition of stroke can make difference between life and death or between complete recovery and lifelong disability
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STR: Smile, Talk, Reach Assessment
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• Smile: Ask person to smile. – Look for uneven smile or
facial droop
• Talk: Ask person to repeat a common phrase. – Listen for slurred or
incorrect words
• Reach: Ask person to close eyes and raise arms. – Look for arm drift or
weakness on one side
ADULT OR CHILD CHOKING
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Key Concepts
• Choking is a preventable emergency• Most choking incidents occur in children younger than 5
years old• Treatment is the same for an adult or child• Act quickly! Severe choking results in death if not treated• Differentiate between choking and other emergencies
(heart attack, asthma, seizure, drug overdose)• Was person
– Talking or drinking alcohol while eating– Eating too fast or not chewing food completely– Wearing dentures while eating (hard to tell if food is chewed)– Walking or running while eating or chewing gum
• Universal sign of choking: 1 or both hands at throat
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Mild Obstruction
• If person can forcefully cough or speak, do not interfere
• Forceful coughing is the best way to relieve an obstruction
• Ask, “Are you choking?”– If can cough or speak,
encourage coughing– Watch for progression to
severe obstruction
• Send someone to call 9-1-1 if coughing is prolonged
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Airway is partially blocked
Severe Obstruction
• Use abdominal thrusts• Ask, “Are you choking?” • If nods or can’t speak:
1. Say you are going to help
2. Stand behind person & reach under arms
3. Place 1 fist just above navel, thumb side in
4. Grasp fist with other hand
5. Give quick upward thrusts until object comes out or the person can breathe or cough
6. Send bystander to call 9-1-1 if cannot quickly clear obstructionCPR/AED for Community Rescuers Adult/Child Choking 132
Airway is completely blocked and person cannot breathe
Unresponsive Choking Person
• Lower person to ground• Send a bystander to call
9-1-1• If alone with adult victim,
go call 9-1-1 now• Perform CPR• Look in mouth after each
set of compressions– If object is seen, remove it– Do not ‘blind sweep’ mouth
• If alone with a child or infant, go call 9-1-1 after 2 min. of CPR
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Pregnant or Larger Victim
• Stand behind person• Reach around chest,
under arms• Place one fist in center
of the chest– Same location as chest
compressions
• Grasp fist with other hand
• Perform continuous backward thrusts
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Use Chest Thrusts
Choking Prevention Tips
• Eat slowly and chew food completely• Do not talk or laugh with food in your mouth• Adults: Don’t drink too much alcohol while
eating; make sure dentures fit well• Children: Cut food into small pieces; cut round
food into halves or quarters• Protect young children from objects small
enough to fit through center of toilet paper roll• Keep children seated and supervised at
mealtime
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INFANT CHOKING
CPR/AED for Community Rescuers 136
Key Concepts
• Choking is a preventable emergency• Most choking incidents occur in children younger
than 5 years old• Treatment for infants is different than for adults
and children
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Signs of Infant Choking
• Signs of Choking– Unable to cry or cough effectively– Difficulty or no breathing– Wheezing or high-pitched sounds– Bluish color skin– Bulging or tearing eyes– Panic or distressed facial expressions
• Mild Obstruction: Infant able to cough or cry– Do not interfere– Observe for progression to severe obstruction– Do not leave the infant– Call 9-1-1 if unsure
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Severe Obstruction
• Send bystander to call 9-1-1– Stay with infant if alone
• Sit or kneel• Hold face down &
provide 5 back slaps• Turn face up & provide
5 chest thrusts• Repeat sequence until
relieved or unresponsive
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Unresponsive Choking Infant
1. Use CPR to remove object
2. Send bystander to call 9-1-1
3. Perform CPR with added step of looking in mouth after compressions
4. Continue CPR until infant begins to breathe
5. Call 9-1-1 after 2 minutes if still alone
CPR/AED for Community Rescuers Infant Choking 140
Discussion: How would you REACT?
• Instructor-led discussion• Review workbook questions• Discuss at least 1 scenario
CPR/AED for Community Rescuers REACT Discussion 141