11.01 Introduction
We have written this second edition of First Aid Guidelines in response to recent changes in philosophy of both the American Red Cross and the American Heart Association. We wrote the first edition in response to USPA’s request to completely revamp and revise both the questions and the entire First Aid Course for the Instructor/Examiner candidates.
We have made this section concise, yet comprehensive enough to cover what we believe anyone in a position of responsibility at a drop zone should know about First Aid and CPR (cardiopulmonary resuscitation). In so doing, we have kept the philosophy of teaching the citizen responder First Aid and CPR comparable to that of the American Red Cross, the American Heart Association, the Armed Forces of the United States, and Professionals in Medicine Parachuting Society, Inc. Therefore, anyone trained by any of these organizations will function in pretty much the same manner during an emergency. Where there are differences in philosophy, we have given what we believe is the safest approach for both the victim and the rescuer.
We do not pretend that even the most careful study of this manual is a substitute for a course and formal certification in First Aid and CPR given by any of the above captioned organizations. We strongly encourage all those in a position of responsibility to take such a course and to remain current in their certification in First Aid and CPR. This manual will thoroughly prepare anyone who studies it for certification in First Aid and CPR.
Professionals in Medicine Parachuting Society, Inc.
6 Tuxedo Drive, Melville, NY 11747
(516) 681-5290 • FAX (516) 681-5302
Stuart G. Selkin, MD, FACS
Chairman, Board of Directors
Claudia L. Roussos MT
President
Department of Surgery
Division of Otolaryngology
Stony Brook University Medical School
Stony Brook, New York
11-1.01 Procedures
A. Recognize that an emergency exists.
B. Decide to act.
C. Call Emergency Medical Service (EMS).
D. Provide First Aid. First Aid is immediate care given to a victim of an injury or sudden illness until more advanced care can be obtained.
E. There are four steps to be taken in every emergency:
1. Analyze the scene.
2. Call EMS.
3. Monitor the ABCs.
4. Check for other injuries.
F. These four steps are presented in more detail:
1. Analyze the scene. Make sure the scene of the emergency is safe for you and for any bystanders. See what happened and how many victims there are. Check for unresponsiveness, then:
2. Call EMS. If there are bystanders, have them call EMS, and provide:
a. Location of the emergency.
b. Caller’s name.
c. What happened.
d. How many victims there are.
e. What is being done for each victim.
3. Monitor the ABCs. This examination checks for life threatening situations.
a. Airway.
b. Breathing.
c. Circulation.
d. Open airway: Tilt head back; clear mouth of foreign matter.
1) If no breathing, initiate rescue breathing.
2) If no pulse, initiate cardiopulmonary resuscitation.
3) Check and care for significant bleeding.
4. Check for other injuries. This examination deals with matters that are not immediately life-threatening, but which, if not taken care of, could be.
a. Try to remain calm.
b. Speak quietly to reassure the victim.
c. "Primo non nocere"–First do no harm.
d. Clear the area of onlookers.
e. If a vehicle is involved:
1) Be wary of gasoline; if there is either spillage or fumes:
2) Do not smoke cigarettes.
3) Do not allow anyone else to smoke.
4) Do not light flares near the downed vehicle.
5) Do not extricate passengers unless it can be done safely.
6) If wires are touching the vehicle or the victims:
a. Do not touch the vehicle.
b. Do not touch or attempt to move the wires.
c. Do not touch the victims who are in contact with the wire.
d. Call the power company.
e. Do not let passengers leave the vehicle.
8) If there is a danger that the vehicle may fall off an embankment:
a. Clear the area of onlookers.
b. Do not let passengers leave the vehicle.
9) If the vehicle is on fire:
a. Do not endanger yourself.
b. Extinguish the fire with one or more of the following:
1. An approved fire extinguisher, not sprayed on people.
2. A blanket.
3. Baking soda.
4. Dirt.
c. Turn off ignition without touching anything else.
d. Extricate victims only if necessary. See basic transport procedures.
f. Do not move the victim, especially if there has been a back or neck injury, unless:
1) There is a threat of fire or explosion or,
2) Crucial care to restore breathing or
circulation cannot be given in place.3) Immobilize all injured parts if possible.
4) Do not straighten fractured or dislocated limbs.
5) Do not remove objects embedded in a person (pieces of metal, branches, etc.)
6) Do not attempt to remove a victim who has been impaled on any object from the object. Immobilize victim and object.
11-1.02 Rescue Breathing
A. Artificial Respiration (Rescue Breathing)
1. Rescue breathing is used only if the victim:
a. Is not breathing at all.
b. Has a heartbeat.
c. If fire, gas, or smoke are present and it is safe for you to enter the scene, move the victim to safety. Follow basic transport procedures.
d. If the victim choked before breathing stopped, see choking.
e. Ask: "Are you O.K.?" or call the victim’s name 2 or 3 times. If the victim does not respond, shake him gently or slap him lightly on the shoulder. If there is no response, call EMS immediately, and turn the victim on his back onto a hard surface such as the ground. Kneel at either side of victim’s head.
2. If the victim is an adult or child 8 or more years old:
a. Using 1 hand, gently lift the victim’s chin while pushing the forehead down with the other hand. Do not do this if there is a neck injury. Check, for about 5 seconds, if the victim is breathing.
1) If there is no breathing, pinch the victim’s nostrils with the fingers of the hand resting on the forehead. While lifting the victim’s chin, take a deep breath. Seal your mouth tightly around the victim’s mouth.
2) Blow 2 breaths watching the victim’s chest rise on each breath. Release your mouth between breaths. Make sure that the victim’s chest rises with each breath. If it does not, clear out all foreign matter and secretions from the victim’s mouth with a finger sweep. Be sure the victim’s head is tilted back to maximum extension, unless there is a neck injury. Repeat 2 full breaths. If the victim’s chest still does not rise, see choking.
b. Check the victim’s neck carefully for a pulse. This is most easily checked at the carotid region, on either side of the neck, about halfway between the front and back of the neck, and halfway between the jaw and collarbone. Do not use your thumb to check the victim’s pulse since there is a pulse in the thumb which can interfere. Never check for both carotid pulses at the same time, since this can kill the victim. The pulse may be very faint.
1) If there is no pulse, initiate cardiopulmonary resuscitation (CPR) immediately.
2) If the victim has a pulse, however faint, continue ventilating him by repositioning the victim’s head (head tilt and chin lift) and providing one breath every 5 seconds. Check the victim’s neck for a carotid pulse every minute (12 cycles), until the victim breathes regularly without assistance. When this occurs, cover the victim with a blanket or extra clothing, keep him quiet, and check for continued breathing. Keep an open airway at all times. If, at any time, the victim loses his carotid pulse, initiate cardiopulmonary resuscitation (CPR).
3. If the victim is a child 1 to 8 years old:
a. Tilt the head slightly back and lift the chin (neutral plus position). Check, for about 5 seconds, if the victim is breathing.
1) If there is no breathing, give 2 gentle breaths, watching the chest rise between each breath. If it does not, clear out all foreign matter and secretions from the victim’s mouth with a finger sweep. Reposition the victim’s head. Repeat giving 2 gentle breaths. If the victim’s chest still does not rise, see chocking. Check the victim’s neck carefully for a pulse. This is most easily checked at the carotid region, on either side of the neck, about halfway between the front and back of the neck, and halfway between the jaw and collarbone. Do not use your thumb to check the victim’s pulse since there is a pulse in the thumb which can interfere. Never check for both carotid pulses at the same time, since this can kill the victim. The pulse may be very faint. Initiate cardiopulmonary resuscitation (CPR) immediately only if there is no pulse.
2) If the victim has a pulse, however faint, continue ventilating him by repositioning the victim’s head (slight head tilt and chin lift) and providing one breath every 3 seconds. Check the victim’s neck for a carotid pulse every minute (20 cycles), until the victim breathes regularly without assistance. When this occurs, cover the victim with a blanket or extra clothing, keep him quiet, and check for continued breathing. Keep an open airway at all times. If, at any time, the victim loses his carotid pulse, initiate cardiopulmonary resuscitation (CPR).
4. If the victim is an infant (under 1 year):
a. Do not tilt the forehead back, but keep the head in a neutral position while lifting the chin with one or two finger(s). Check, for about 5 seconds, if the victim is breathing.
1) If there is no breathing, do not pinch the victim’s nostrils. Seal your mouth over the victim’s nose and mouth. Blow only 2 small puffs of air. Be aware of how little air is needed to inflate an infant’s lungs. Be careful not to overinflate the infant’s lungs. Make sure that the victim’s chest rises with each breath. If it does not, clear out all foreign matter and secretions from the victim’s mouth with a finger sweep. Reposition the victim’s head. Repeat 2 small puffs. If the victim’s chest still does not rise, see choking.
b. Check above the victim’s left nipple for 5 to 10 seconds to see if there is still a pulse. The pulse may be very faint. If there is none, initiate cardiopulmonary resuscitation (CPR) immediately.
1) If the victim does have a pulse, however faint, reposition the victim’s head and continue ventilating for him at a rate of 1 breath every 3 seconds. Check above the victim’s left nipple for a pulse every 1 minute (20 cycles), until he or she breathes regularly without assistance. When this occurs, cover the victim with a blanket or extra clothing, keep him quiet, and check for continued breathing. If at any time the victim loses his pulse, initiate cardiopulmonary resuscitation (CPR).
B. Rescue breathing is difficult work. You must expect to become tired. Continue rescue breathing until:
1. The victim begins breathing on his/her own; or
2. Professional help arrives; or
3. You are too exhausted to continue.
Adult or Child Infant
Older Child (1–8 Years)
Check for unres- Check for unres- Check for unres-ponsiveness. ponsiveness. ponsiveness.
Call EMS. Call EMS. Call EMS.
2 slow breaths. 2 slow breaths. 2 slow breaths.
Check carotid pulse. Check carotid pulse. Check carotid pulse.
1 breath/5 sec. 1 breath/3 sec. 1 breath/3 sec.
Check pulse after Check pulse after Check pulse after 1 min or 12 cycles. 1 min or 20 cycles. 1 min or 20 cycles.
C. Cardiopulmonary Resuscitation (CPR)
1. Cardiopulmonary Resuscitation (CPR) is used only if the victim:
a. Is not breathing at all, and
b. Has no heartbeat (pulse).
1) If there is no heartbeat, the victim will not be able to breath, since no blood will reach the lungs or the brain.
2. Do not use CPR if the victim has a pulse, however faint. If the victim has a pulse, but is not breathing, initiate rescue breathing.
3. If fire, gas, or smoke are present and it is safe for you to enter the scene, move the victim to safety. Follow basic transport procedures.
4. If the victim choked before breathing stopped, see choking.
5. Ask: "Are you O.K.?" or call victim’s name 2 or 3 times. If victim does not respond, shake him gently or slap him lightly on the shoulder. If there is no response, turn the victim on his back onto a hard surface such as the ground. Kneel at either side of the victim’s head.
6. If the victim is an adult or child 8 or more years old:
a. Using 1 hand, gently lift the victim’s chin while pushing the forehead down with the other hand. Do not do this if there is a neck injury. Check, for about 5 seconds, if the victim is breathing.
1) If there is no breathing, pinch the victim’s nostrils with the fingers of the hand resting on the forehead. While lifting the victim’s chin, take a deep breath. Seal your mouth tightly around the victim’s mouth.
2) Blow 2 breaths watching the victim’s chest rise on each breath. Release your mouth between breaths. Make sure that the victim’s chest rises with each breath. If it does not, clear out all foreign matter and secretions from the victim’s mouth with a finger sweep. Be sure the victim’s head is tilted back to maximum extension, unless there is a neck injury. Repeat 2 full breaths. If the victim’s chest still does not rise, see choking.
b. Check the victim’s neck carefully for a pulse. This is most easily checked at the carotid region, on either side of the neck, about halfway between the front and back of the neck, and halfway between the jaw and collarbone. Do not use your thumb to check the victim’s pulse since there is a pulse in the thumb which can interfere. Never check for both carotid pulses at the same time, since this can kill the victim. The pulse may be very faint. If there is a pulse, however faint, continue only ventilation by rescue breathing at a rate of 1 breath every 5 seconds.
1) If there is no pulse, follow the victim’s rib cage up to the center of his chest. Place your index and middle finger on the tip of the victim’s breastbone. Place the heel of your free hand next to and touching the index finger of the first hand, so that it is centered on the breastbone. Place the heel of the first hand over the wrist of the second hand on the victim’s breastbone. Clasp fingers and bend those of the lower hand back. Lean directly over the victim and straighten your arms. Use straight down pressure through both arms to push breastbone against heart. Depress 1 1/2 inches to 2 inches. This compression relaxation combination is done at a rate of 80-100 times per minute. Completely release pressure during the relaxation phase without lifting your hands from the victim’s chest. After 15 compressions, breathe twice into the victim’s mouth. Repeat the 15 compression/relaxation to 2 breaths cycle until the victim is revived or until you can no longer continue. Check for pulse and breathing every 4 cycles. If the pulse returns, continue only ventilation by rescue breathing at a rate of 1 every 5 seconds until the victim is revived. When the victim is revived, keep him warm, and check for continued breathing and pulse. Keep the airway open.
7. If the victim is a child 1 to 8 years old:
a. Tilt the head slightly back and lift the chin (neutral plus position). Check, for about 5 seconds, if the victim is breathing.
1) If there is no breathing, give 2 breaths watching the chest rise between each breath. If it does not, clear out all foreign matter and secretions from the victim’s mouth with a finger sweep. Reposition the victim’s head. Repeat giving 2 breaths. If the victim’s chest still does not rise, see chocking. Check the victim’s neck carefully for a pulse. This is most easily checked at the carotid region, on either side of the neck, about halfway between the front and back of the neck, and halfway between the jaw and collarbone. Do not use your thumb to check the victim’s pulse since there is a pulse in the thumb which can interfere. Never check for both carotid pulses at the same time, since this can kill the victim. The pulse may be very faint.
b. If the victim has no pulse, place the heel of your free hand next to and touching the index finger of the first hand, so that it is centered on the breastbone. Place the heel of the first hand on the victim’s forehead. You will perform CPR with one hand only, on the victim’s breastbone. Lean directly over the victim and straighten your arm. Use straight down pressure to push the breastbone against the heart. Depress 1 inch to 1 1/2 inches. Completely release pressure during the relaxation phase without lifting your hands from the victim’s chest. After 5 compressions, breathe once into the victim’s mouth, watching the victim’s chest rise. Repeat the 5 compression/relaxation to 1 breaths cycle until the victim is revived or EMS arrives, or until you can no longer continue. Check for pulse and breathing every minute (about 20 cycles). If the pulse returns, continue only ventilation by rescue breathing at a rate of 1 every 3 seconds until the victim is revived. When the victim is revived, keep him warm, and check for continued breathing and pulse. Keep the airway open.
8. If the victim is an infant (under 1 year):
a. Do not tilt the forehead back, but keep the head in a neutral position while lifting the chin with one or two finger(s). Check, for about 5 seconds, if the victim is breathing.
1) If there is no breathing, do not pinch the victim’s nostrils. Seal your mouth over the victim’s nose and mouth. Blow only 2 small puffs of air. Be aware of how little air is needed to inflate an infant’s lungs. Be careful not to overinflate the infant’s lungs. Make sure that the victim’s chest rises with each breath. If it does not, clear out all foreign matter and secretions from the victim’s mouth with a finger sweep. Reposition the victim’s head. Repeat 2 small puffs. If the victim’s chest still does not rise, see choking.
b. Check above the victim’s left nipple for 5 to 10 seconds to see if there is still a pulse. The pulse may be very faint. If there is a pulse, however faint, continue only ventilation by rescue breathing at a rate of 1 breath every 3 seconds.
1) If there is no pulse, place two fingers in the middle of the breastbone and give 5 compressions, taking only about 3 seconds. After 5 compressions, give one puff, watching the chest gently rise. Continue CPR for about one minute (about 20 cycles), then recheck pulse. Repeat the 5 compression/relaxation to 1 breaths cycle until the victim is revived or EMS arrives, or until you can no longer continue. Check for pulse and breathing every minute (about 20 cycles). If the pulse returns, continue only ventilation by rescue breathing at a rate of 1 every 3 seconds until the victim is revived. When the victim is revived, keep him warm, and check for continued breathing and pulse. Keep the airway open.
9. Cardiopulmonary resuscitation (CPR) is difficult work. You must expect to become tired. Continue CPR until:
a. The victim begins breathing on his/her own; and
b. The victim’s pulse continues on its own; or
c. Professional help arrives; or
d. You are too exhausted to continue.
Adult Child Infant
or Older Child (1–8 years)
Check for unres- Check for unres- Check for unres-ponsiveness. ponsiveness. ponsiveness.
Call EMS. Call EMS. Call EMS.
2 slow breaths. 2 slow breaths. 2 slow breaths.
Check carotid Check carotid Check carotid pulse. pulse. pulse.
No pulse: 15 No pulse: 5 chest No pulse: 5 chest chest compress- compressions fol- compressions fol-ions followed by lowed by 1 breath. lowed by 1 breath. 2 breaths.
Check pulse after Check pulse after Check pulse after 4 cycles. 12 cycles. 12 cycles.
11-1.03 Choking
A. Signs and symptoms of choking:
1. Clutching throat
(this is a universal signal for choking).2. Initial coughing with gasping, then:
3. Inability to cough, speak or breathe.
4. If the victim can cough or speak, the victim can breathe.
5. Sudden loss of consciousness while eating.
6. Blue/gray skin, fingernails, and mucous membranes.
B. If the victim has been injured, do not move him unless necessary.
1. If the victim is an adult or child 8 or more years old, and is awake (not unconscious):
a. Determine that the victim is choking. Shout for help, and call (or have someone call) EMS. With the victim standing, wrap both arms around him from behind. Make a fist with one hand, covering it with the other. Place the thumb side of your fist just above the victim’s navel, but below the rib cage. Thrust your fist sharply upward and back into the victim’s abdomen. Repeat 5 times. If the victim vomits, turn his head to either side, and wipe foreign matter and secretions out of his mouth by sweeping it with your finger. If the victim is obese or pregnant, place your fist in the center of the victim’s chest and thrust backwards. Encourage the victim to continue coughing. Repeat thrusts until the object is dislodged, or until the victim becomes unconscious.
2. If the victim is an adult or child 8 or more years old, and is unconscious:
a. Shout for help, and call (or have someone call) EMS.
b. Be sure the victim is lying down, in a face up position. If necessary, turn the victim to a face up position. Attempt to dislodge and remove foreign matter and secretions by sweeping it with your finger.
c. Using 1 hand, gently lift the victim’s chin while pushing the forehead down with the other hand. Do not do this if there is a neck injury.
1) Pinch the victim’s nostrils with the fingers of the hand resting on the forehead. While lifting the victim’s chin, take a deep breath. Seal your mouth tightly around the victim’s mouth. If a pocket mask is available, this is preferable to direct contact.
2) Blow 2 full breaths. Release your mouth between breaths. Make sure that the victim’s chest rises with each breath. If it does not, clear out all foreign matter and secretions from the victim’s mouth with a finger sweep. Be sure the victim’s head is tilted back to maximum extension, unless there is a neck injury. Repeat 2 full breaths. If the victim’s chest still does not rise, straddle the victim’s thighs. Place hands flat, one on top of the other in a crossed position, just above the victim’s navel, but below the victim’s rib cage. Thrust the heel of your bottom hand into the victim’s abdomen with a quick upward thrust. Repeat 5 times. If the victim vomits, turn his head to either side, and wipe foreign matter and secretions out of his mouth with your fingers.
3) If the object is not dislodged, repeat the cycle of 5 abdominal thrusts, a finger sweep, followed tilting the head back, pinching the nose shut, and giving 2 full breaths. Continue this cycle until the object is expelled, you can breathe into the victim, or EMS personnel arrive and take over.
3. If the victim is a child 1 to 8 years old:
a. Follow the same sequence as for an adult, but use much less force.
4. If the victim is an infant (under 1 year):
a. Shout for help, and call (or have someone call) EMS.
b. Turn and hold the infant face down, supporting its head on your forearm, and supporting your forearm on your thigh. Deliver 5 sharp blows with the heel of your hand to its back, between its shoulder blades. Turn the infant onto its back, supporting the head and neck on your forearm, and supporting your forearm on your thigh. Place your middle and index finger on the middle of the infant’s breastbone and quickly compress the breastbone 1/2 inch to 1 inch on each thrust. Repeat the cycle of turning the infant face down, delivering 5 back blows, then turning the infant onto its back and giving 5 chest thrusts until the object is coughed up, or the infant starts to cry, cough, or breathe, If the infant becomes unconscious, grasp the tongue and lower jaw and lift the jaw. Try to remove foreign objects with a finger sweep from the inside of the cheek to the base of the tongue. Keep the head in the neutral position and lift the chin, seal your lips around the infant’s nose and mouth and give 2 gentle puffs for 1 to 1 1/2 seconds each, watching the chest gently rise. If the breaths do not go in and the chest does not rise, turn and hold the infant face down, supporting its head on your forearm, and supporting your forearm on your thigh. Deliver 5 sharp blows with the heel of your hand to its back, between its shoulder blades. Turn the infant onto its back, supporting the head and neck on your forearm, and supporting your forearm on your thigh. Place your middle and index finger on the infant’s breastbone and quickly compress the breastbone 1/2 inch to 1 inch on each thrust. Repeat the cycle of turning the infant face down, delivering 5 back blows, then turning the infant onto its back and giving 5 chest thrusts until the object is coughed up, or the infant starts to cry, cough, or breathe, or until the EMS arrives.
Remember: If the victim can cough or speak, the victim can breathe and is not choking.
11-1.04 Shock
Shock is a failure of the body to circulate oxygen-rich blood to all parts of the body. It may be caused by severe injury, bleeding, or a heart attack. As shock worsens, the vital organs (heart, lungs, kidneys, brain) stop functioning, and the victim will die.
A. Signs and symptoms of shock:
1. Restlessness or irritability.
2. Rapid, weak pulse.
3. Rapid breathing.
4. Pale or blue, cool, moist skin.
5. Excessive thirst.
6. Nausea and vomiting.
7. Drowsiness or loss of consciousness.
B. First Aid for shock:
1. Call EMS.
2. Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
3. Help the victim rest in order to reduce pain. Pain will make shock worse.
4. Keep the victim warm, with clothing or blankets.
5. Control external bleeding.
6. Elevate the legs about 12 inches, unless you suspect fractures of extremities.
7. Do not give the victim anything to drink or to eat.
8. Speak calmly and reassuringly to the victim.
C. How to care for external bleeding:
1. Direct pressure will stop most bleeding. Apply pressure with your or the victim’s hand, via a thick sterile, or clean gauze pad or other material. The material will help prevent infection. As a last resort, use your bare hand. Do not remove original pads. Let blood soak through and begin to clot. If necessary, place additional pads over the original and apply pressure for 5 to 10 minutes and elevate the area unless you suspect a fracture. If you suspect a fracture, do not elevate the injured part. When bleeding slows, tape the original dressing in place. Check the nail beds of fingers and toes for color, making sure they are not blue. If they are, or if there is no pulse in the wrist or on the foot, the dressing must be loosened. Do not apply a tourniquet.
11-1.05 Basic Transport Procedures
A. Do not move the victim unless there is danger to the
victim or to the rescuer.B. If there is a possibility of neck or back injury, see back and neck injuries.
C. If the victim is injured, unconscious, or is having a heart attack, and a stretcher, board, or blanket is available:
1. Lay it along the victim’s more injured side. Gather a blanket lengthwise in folds. Grasp victim’s hips and shoulder, and gently roll him onto the less injured side. Slide board or blanket underneath the victim, then roll him gently onto his back.
2. If there is 1 rescuer: Grasp stretcher, board, or blanket under the victim’s head and neck and pull him to safety.
3. If there are 2 or more rescuers: Stand on either side of the victim, lift slowly and simultaneously, and take the victim to safety.
D. If the victim is injured, unconscious, or is having a heart attack, and a stretcher, board, or blanket is not available:
1. If there is 1 rescuer: Place the victim on his back. Stand at the victim’s head, supporting his head and back of neck. Slowly drag the victim to safety using the victim’s clothing. Keep the victim low to ground. Do not pull clothing so tight that it blocks the airway.
2. If there are 2 or more rescuers: 2 rescuers stand on the same side of the victim, facing him. The rescuer nearest the victim’s feet places one arm under the victim’s knees, and crosses the other arm over the victim’s hips. The rescuer nearest the victim’s head places the arm closest to the first rescuer underneath the victim’s hip and grasps the first rescuer’s hand. The other arm supports the victim’s neck and back. If a third rescuer is available, he or she supports the victim’s legs. All rescuers then carry the victim to safety.
E. If the victim is not injured, is not unconscious, and is not having a heart attack, place his arm around your neck and support at the waist. If the victim is too heavy or too weak, use blanket or clothes drag described above.
11-1.06 Fractures and Dislocations
A. Signs and symptoms of fractures or dislocations:
1. Sound of bone snapping.
2. Deformity.
3. Swelling.
4. Discoloration (black and blue, bleeding under skin).
5. Possible grating of bony ends on each other.
6. Pain, usually made worse by movement.
7. Tenderness to touch.
8. Loss of movement around a joint.
9. Shorter or longer extremity as compared with the other side.
10. Muscle spasm.
B. Signs and symptoms of fractures, dislocations, sprains, and strains are very similar, and often not distinguishable from each other. It is not the rescuer’s role to do this.
C. First Aid for fractures and dislocations:
1. The primary objective is to immobilize a suspected fracture. Splint the injured limb in place with rolled towels, blankets, pillows, newspapers or clothing, one joint above, and one joint below the injury. Do not attempt to set the fracture or straighten the injured part.
2. The most common fractures in parachutists involve the ankle. Since boots and shoes provide stability, do not attempt to remove them. Rolled towels, blankets, pillows, newspapers or clothing will provide additional stability.
3. See back and neck injuries.
4. If a bone fragment is protruding through the skin (a compound fracture), do not attempt to push it back. Cover it with sterile or clean gauze or cloth.
5. Direct pressure will stop most bleeding. Apply pressure with your or the victim’s hand, via a thick sterile, or clean gauze pad or other material. The material will help prevent infection. As a last resort, use your bare hand. Do not remove original pads. Let blood soak through and begin to clot. If necessary, place additional pads over the original and apply pressure for 5 to 10 minutes. Since you suspect a fracture, do not elevate the injured part. When bleeding slows, tape the original dressing in place. Check the nail beds of fingers and toes for color, making sure they are not blue. If they are, or if there is no pulse in the wrist or on the foot, the dressing must be loosened.
6. Allow the victim as little movement as possible.
7. A very significant amount of bleeding can occur at a fracture site, especially of the upper leg (femur) or pelvis. See shock.
8. If the jaw is dislocated, give the victim nothing to eat or drink.
11-1.07 Neck and Back Injuries
Suspect injury of the neck or back as well as head injury if victim is dazed, groggy, or unconscious from any injury, or if there has been a fall or injury to the back.
A. Signs and symptoms of a fracture of the neck or back:
1. Severe pain at the site of injury.
2. Tenderness to pressure at the site of injury.
3. Deformity at the site of injury.
4. Discoloration (black and blue, bleeding under skin).
5. Pain on movement at the site of injury.
6. Possible paralysis of one or more limbs.
7. Numbness of one or more limbs.
B. First Aid for neck and back injuries:
1. Do not move the victim if there has been a back or neck injury; unless there is a threat of fire or explosion, or if crucial emergency care to restore breathing or circulation cannot be given at the victim’s present location.
2. If the victim is in a safe area:
a. Leave the victim in his present position, and cover him with a blanket. Secure his neck very carefully, using a collar or pillows, towels, or rolled blankets, or clothing placed around his head, and neck, and then entire body. Keep his head straight; do not raise or lower the chin; do not turn the head.
3. If the victim is in an unsafe area:
a. If the victim is on his back, gather his clothes behind his neck. Using victim’s clothes, pull him to safety, cradling his head in clothing and your hands.
b. If the victim is not lying on his back, it is extremely dangerous to move him. If necessary, the rescuer must cradle the victim’s neck and head with his (the rescuer’s) forearms, turn the victim in a straight line, and move him to safety.
c. If 2 or more rescuers, and an ironing board, door, or leaf from a table are available, place it beside the victim. One rescuer coordinates turning victim’s head. Other rescuers grasp victim’s clothing and turn him onto his back, onto the board. The victim’s head must be kept straight. Middle rescuer slides board under victim. Immobilize victim by placing pillows, towels, or rolled blankets around his entire body. Secure victim to board with belts, ties, straps, rope.
4. Do not move the victim’s head in line with his body if:
a. The victim’s neck is angled significantly to one side.
b. The victim has pain on movement of the neck.
c. The victim meets resistance when attempting to move his head.
C. Monitor ABCs. If breathing stops, roll victim onto his back, keeping neck and head as straight as possible and initiate rescue breathing. If pulse stops, roll victim onto his back, keeping his neck and head as straight as possible and initiate cardiopulmonary resuscitation (CPR).
11-1.08 Burns
Burns may be caused by thermal (heat) factors, lightning,
electric shock, chemicals, and excess exposure to the sun. If in doubt about
the classification of a burn, choose the more serious one.
A. First degree burn:
1. Redness of skin.
2. Pain.
3. Mild swelling.
B. Second degree burn:
1. Blistering of the skin.
2. Deep reddening of skin.
3. Glossy appearance.
4. Leaking of fluid.
5. Sometimes loss of some skin.
6. If over 10% of the body, is to be considered serious.
C. Third degree burn:.
1. Loss of full thickness of skin.
2. Possible charred edges.
3. If over 2% of the body, is to be considered severe.
D. If wires are touching the vehicle or the victims:
1. Do not touch the vehicle.
2. Do not touch or attempt to move the wires.
3. Do not touch the victims who are in contact with the wire.
4. Call the power company.
5. Do not let passengers leave the vehicle
E. Treating burns:
1. Monitor the ABCs. If breathing stops, initiate rescue breathing. If pulse stops initiate cardiopulmonary resuscitation (CPR).
2. Cut clothing and jewelry away from the burned area unless it sticks to the burn.
3. For chemical burns:
a. Flush the area thoroughly with cool water for at least 5 minutes. This is especially important if the chemical burn affects the victim’s eye.
4. For first degree burns:
a. Apply cold wet compresses to the burned area, or immerse the area into cold water for 5 to 10 minutes. Do not use ice.
b. Leave the area uncovered if possible, or cover with a dry sterile or clean gauze.
c. Do not apply ointments.
5. For second degree burns:
a. Apply cold wet compresses to the burned area, or immerse the area into cold water for 5 to 10 minutes. Do not use ice.
b. Do not open or break blisters.
c. If an extremity is involved, keep it elevated.
d. If burns are extensive, keep the victim flat, with both legs elevated.
e. Cover the burned area with sterile or clean gauze or cloth.
f. Do not apply ointments.
6. Consult a physician. In case of shock call EMS.
a. There may be signs and symptoms of shock:
1) Restlessness or irritability.
2) Rapid, weak pulse.
3) Rapid breathing.
4) Pale or blue, cool, moist skin.
5) Excessive thirst.
6) Nausea and vomiting.
7) Drowsiness of loss of consciousness.
b. First Aid for shock:
1) Call EMS.
2) Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
3) Help the victim rest in order to reduce pain. Pain will make shock worse.
4) Keep the victim warm, with clothing or blankets.
5) Control any external bleeding.
6) Elevate the legs about 12 inches unless you suspect fractures of extremities.
7) Do not give the victim anything to drink or to eat.
8) Speak calmly and reassuringly to the victim.
7. For third degree burns:
a. Call EMS immediately.
b. Unless there is a chemical burn, do not wet the burned area in any way.
c. If the head or face are involved, have the victim sit up. Otherwise, keep him flat, with legs elevated.
d. Do not apply ointments.
e. There may be signs and symptoms of shock:
1) See above for signs and symptoms of shock.
2) See above for First Aid for shock.
11-1.09 Heat Emergencies
Heat Cramps, Heat Exhaustion, and Heat Stroke
A. Heat Cramps
1. Signs and symptoms of heat cramps:
a. Severe muscle cramps, especially in legs.
b. Body temperature is usually normal.
c. Skin is moist.
2. First Aid for heat cramps:
a. If possible, bring the victim indoors.
b. Outdoors, move the victim to a shaded area.
c. Fan the victim vigorously.
d Give plenty of fluids to drink.
B. Heat Exhaustion
1. Signs and symptoms of heat exhaustion:
a. Cool, pale, clammy skin.
b. Fatigue.
c. Fainting.
d. Headache.
e. Heavy sweating.
f. Weak pulse.
g. Nausea.
h. Gradual onset.
i. The victim is alert.
j. Near normal body temperature.
2. First Aid for heat exhaustion:
a. Call EMS if the victim vomits, refuses to drink, or becomes drowsy.
b. If possible, bring the victim indoors.
c. Outdoors, move the victim to a shaded area.
d. Fan the victim vigorously.
e. If the victim is fully conscious, give sips of cool water to drink.
f. Loosen or remove the victim’s clothing.
g. Cool the victim’s skin by applying wet, lukewarm or cool cloths on face and extremities. Evaporation will do the work.
h. Do not let the victim do any exercise for the remainder of the day.
C. Heat Stroke
1. Signs and symptoms of heat stroke:
a. Red, hot, dry skin.
b. No perspiration.
c. Rapid pulse.
d. Convulsions.
e. Stupor or unconsciousness.
f. Very high body temperature (around 106o F).
g. Cardiac or respiratory arrest and death.
2. First Aid for heat stroke:
a. Call EMS immediately since this is a life threatening situation.
b. If possible, bring the victim indoors.
c. Outdoors, move the victim to a shaded area.
d. Fan the victim vigorously.
e. If the victim is fully conscious, give sips of cool, but not cold water to drink.
f. Loosen or remove the victim’s clothing.
g. Cool the victim’s skin by applying wet, lukewarm or cool cloths on face and extremities. Evaporation will do the work.
h. This is a much more serious situation than is heat exhaustion, and may be fatal.
i. Have the victim lie down, and elevate his legs.
j. Monitor the ABCs. If breathing stops, initiate rescue breathing. If pulse stops initiate cardiopulmonary resuscitation (CPR).
k. If convulsions occur, see convulsions.
11-1.10 Cold Emergencies
Frostbite and Hypothermia
A. Frostbite occurs in body parts exposed to the cold, and is a freezing of the tissues. It typically affects fingers, toes, and the nose.
1. Signs and symptoms of frostbite:
a. Pain in affected part.
b. Severe itching of affected part.
c. White or grayish-yellow skin.
d. Extreme coldness of affected part.
e. Numbness of affected part.
f. Blisters.
2. First Aid for frostbite:
a. Remove any and all wet clothing, even if it must be cut away.
b. Do not rub the affected part.
c. Fill a pot with warm water (about 100° F to 104° F); immerse affected part.
d. If this cannot be done, soak clean cloths or sponges in the warm water, and apply to the frostbitten parts.
e. Keep the affected part in water until it is red and feels warm.
f. Bandage with dry, sterile dressings, putting dressing between fingers or toes.
g. Do not break any blisters.
h. If the victim is conscious and alert, give him warm liquids to drink.
i. Do not allow the victim to smoke, as this will cause blood vessels to narrow.
j. Do not give alcoholic beverages, as this will cause further loss of body heat from dilating (widening) the superficial vessels.
B. Hypothermia is a general body cooling that develops when the body cannot generate enough heat to maintain normal body temperature. Hypothermia is life-threatening.
1. Signs and symptoms of hypothermia:
a. Low body temperature.
b. Uncontrollable shivering.
c. Poor muscle coordination.
d. Shallow breathing.
e. Numbness.
f. Confusion, drowsiness.
g. Loss of consciousness.
h. Death.
2. First Aid for hypothermia:
a. This is a life threatening emergency. Call EMS immediately.
b. Remove any and all wet clothing, even if it must be cut away.
c. Wrap the victim in blankets and dry clothing.
d. Move the victim inside, where it is warm.
e. If the victim is conscious and alert, give warm liquids to drink.
f. Do not allow the victim to smoke, as this will cause blood vessels to narrow.
g. Do not give alcoholic beverages, as this will cause further loss of body heat from dilating (widening) the superficial vessels.
h. Monitor the ABCs: If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
i. If available, use a hot water bottle or heating pad to warm the victim. Be careful not to burn the victim.
11-1.11 Convulsions (Seizures)
A. Signs and symptoms of convulsions:
1. Involuntary jerking of muscles.
2. Possible loss of bowel and bladder control.
3. Unconsciousness.
4. Cessation of breathing.
5. The victim may appear to be dazed.
B. First Aid for convulsions:
1. Clear the area of harmful objects.
2. Do not try to hold the victim down.
3. Surround the victim with rolled blankets, pillow, or clothing for protection.
4. Pay special attention to protection of the victim’s head.
5. Do not place anything between the victim’s teeth.
6. Do not interfere with convulsive movements.
7. Do not give the victim anything to drink or eat.
8. Monitor the ABCs and call EMS. If breathing stops, initiate rescue breathing. If pulse stops initiate cardiopulmonary resuscitation (CPR).
9. If the victim has a head injury see head injury.
10. If the victim has ingested any poison, call Poison Control.
11. If the victim has a high fever after convulsions stop, cool him down by applying wet, lukewarm cloths on face and extremities. Evaporation will do the work.
12. After convulsions stop, cover the victim with a
blanket.
11-1.12 Head Injury
The brain is enclosed in a rigid, unyielding skull. There is no room for expansion from swelling, or from bleeding which may follow an injury. When brain swelling or bleeding occurs, vital centers may be compressed, and breathing and circulation may stop. Thus, a head injury may be rapidly life threatening. A skull fracture is not life threatening; the swelling of the brain that may accompany it can be. A concussion is defined by the neurosurgeons as a temporary loss of consciousness, with inability to recall the injury.
A. Signs and symptoms of head injury:
1. Alteration of consciousness.
2. Disorientation as to time, place, or person.
3. Dizziness.
4. Double vision.
5. Nausea and/or vomiting, especially if progressively increasing.
6. Pupils of unequal size.
7. Pupils that do not constrict (narrow) to the stimulus of light.
8 Convulsions.
9. Slurred speech.
10. Paralysis of any extremity, especially if on the side opposite to the injury.
11. Headache, especially if progressively increasing.
B. Signs and symptoms of a skull fracture:
1. Depression of a region of the skull.
2. Clear fluid (cerebrospinal fluid, or CSF) from the ears, nose, or mouth.
3. Bleeding or bloody fluid from the ears, nose, or mouth.
4. Do not give the victim anything to eat or to drink.
5. Monitor the ABCs. If breathing stops, initiate rescue breathing. If pulse stops initiate cardiopulmonary resuscitation (CPR).
a. Keep the airway clear. Clear out all foreign matter (like dentures and fractured teeth) and secretions from the victim’s mouth with a finger sweep.
6. Assume that there is a neck injury. See back and neck injury.
7. If the victim has convulsions see convulsions.
8. If there is an open wound of the face or of the skull, see wounds. Direct pressure will stop most bleeding. Apply pressure with your or the victim’s hand, it via a thick sterile, or clean gauze pad or other material. The material will help prevent infection. As a last resort, use your bare hand. Keep the injured area elevated. Do not remove original pads. Let blood soak through and begin to clot and elevate injured part. If necessary, place additional pads over the original and apply pressure for 5 to 10 minutes. When bleeding slows, tape the original dressing in place. If the dressing is very tight, it may be loosened gradually.
9. If there is a foreign object penetrating the eye:
a. Do not attempt to remove it.
b. If it is long, do not attempt to shorten it.
c. Do not attempt to stop any bleeding from the eye.
d. Pack gauze around it.
e. Tape a paper cup over the eye and the foreign object.
10. If the victim has a nosebleed:
a. Sit him up so that gravity will help stop the bleeding.
b. Lean the victim’s head slightly forward.
c. Pinch the nostrils shut.
d. Soak a little cotton in Afrin or neosynephrine, and place it in each nostril.
11-1.13 Chest Injury
Call EMS.
A. There may be signs and symptoms of shock:
1. Restlessness or irritability.
2. Rapid, weak pulse.
3. Rapid breathing.
4. Pale or blue, cool, moist skin.
5. Excessive thirst.
6. Nausea and vomiting.
7. Drowsiness of loss of consciousness.
B. First Aid for shock:
1. Call EMS.
2. Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
3. Help the victim rest in order to reduce pain. Pain will make shock worse.
4. Keep the victim warm, with clothing or blankets.
5. Control any external bleeding.
6. Elevate the legs about 12 inches unless you suspect fractures of extremities.
7. Do not give the victim anything to drink or to eat.
8. Speak calmly and reassuringly to the victim.
C. Signs and symptoms of a "sucking" chest wound:
1. Deep wound in the chest penetrating the lung.
2. The sound of air being drawn into the chest may be audible.
3. Hissing sound may be audible.
4. Loud, grunting breathing.
D. First Aid for a sucking chest wound:
1. Cover the entire wound. Use a plastic bag, plastic wrap, or aluminum foil. If nothing else is available, use your hand. If you do not cover the wound, air pressure inside and outside the chest will become equal, and the victim will be unable to breathe.
2. Do not probe for objects.
3. Do not remove any protruding objects.
4. Have the victim exhale and hold it while you press the dressing firmly on the wound. Fix the dressing tightly in place, taping it all around.
5. Turn the victim onto the injured side.
E. Signs and symptoms of a "flail" chest:
1. All or a portion of the chest collapses when the victim inhales.
F. First Aid for a flail chest:
1. Turn the victim onto the injured side, with a pillow or blanket or rolled clothing under the moving section of the chest.
2. Immobilize the moving section of the chest with tape or with a heavy object wrapped in a towel or a blanket.
3. Keep the victim’s head elevated slightly.
4. Have the victim cough in order to clear the lungs.
11-1.14 Abdominal Injury
Call EMS.
A. There may be signs and symptoms of shock:
1. Restlessness or irritability.
2. Rapid, weak pulse.
3. Rapid breathing.
4. Pale or blue, cool, moist skin.
5. Excessive thirst.
6. Nausea and vomiting.
7. Drowsiness of loss of consciousness.
B. First Aid for shock:
1. Call EMS.
2. Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
3. If the victim vomits, turn his head to either side, and wipe foreign matter and secretions out of his mouth with your fingers.
4. Help the victim rest in order to reduce pain. Pain will make shock worse.
5. Keep the victim warm, with clothing or blankets.
6. Control any external bleeding.
7. Elevate the legs about 12 inches unless you suspect fractures of extremities.
8. Do not give the victim anything to drink or to eat.
9. Speak calmly and reassuringly to the victim.
C. In addition, there may be:
1. Rigid abdomen.
2. Abdominal pain.
3. Localized tenderness and swelling.
4. Bloody or "coffee grounds" vomit.
5. Smoky or bloody urine.
6. Dark, bloody, or tar-like stools
7. Pink or bloody sputum.
8. Elevate the victim’s knees with a rolled blanket or pillow to relax abdominal muscles.
D. Abdominal Wounds:
1. If there is an open wound with organs protruding (evisceration) do not try to replace the organs. Cover the organs with a sterile, nonadherent dressing. If none is available, use a clean sheet or towel wet with cool water, or plastic wrap, or aluminum foil. Then place an outer bandage to hold the dressing in place. Do not apply pressure.
2. If there is an open wound with a foreign object penetrating (either with or without an evisceration), do not attempt to remove the foreign object. Do not attempt to remove a victim who has been impaled on an object (a fence post, a branch, etc). Immobilize victim and object.
3. If there is an open wound and there is no foreign object and no evisceration, control bleeding by covering with thick sterile (or clean) gauze, and applying gentle pressure with the palm of your hand. If bleeding does not slow down, apply more gauze over the present gauze, and continue gentle, firm, continuous pressure. Do not remove original gauze.
11-1.14 Wounds
A. Definition of a deep wound:
1. Heavy bleeding.
2. Involvement of underlying tissues (muscles, nerves, tendons and blood vessels).
B. First Aid for a deep wound:
1. Direct pressure will stop most bleeding. Apply pressure with your or the victim’s hand, it via a thick sterile, or clean gauze pad or other material. The material will help prevent infection. As a last resort, use your bare hand. Do not remove original pads. Elevate injured part. Let blood soak through and begin to clot. If necessary, place additional pads over the original and apply pressure for 5 to 10 minutes. When bleeding slows, tape the original dressing in place. Check the nail beds of fingers and toes for color, making sure they are not blue. If they are, or if there is no pulse in the wrist or on the foot, the dressing must be loosened.
2. Immobilize and elevate the injured part with pillows, blankets, or clothing, If you suspect a fracture, do not elevate the injured part, but be sure to immobilize it.
3. Be aware and treat for shock.
4. Do not use a tourniquet for any reason.
5. If the wound is on the victim’s head, keep it elevated. If not, have the victim lie down, and elevate the legs.
a. If the wound is on the face, do not let the dressing choke the victim.
6. If a part has been amputated:
a. Rinse it in clean water.
b. Wrap it in sterile or clean gauze or cloth.
c. Seal it in a plastic bag.
d. Place the bag in ice water
7. If a tooth has been knocked out, seal it in a plastic bag.
8. Cover the victim with a blanket in order to retain body heat.
9. Monitor the ABCs. If breathing stops, initiate rescue breathing. If pulse stops initiate cardiopulmonary resuscitation (CPR).
11-1.15 Chest Pain
A. Monitor the ABCs. If at any time the victim stops breathing initiate rescue breathing. If pulse stops initiate cardiopulmonary resuscitation (CPR).
B. If the victim has fallen or has been struck on the chest see chest injury.
C. Suspect a heart attack if the victim has any of the following:
• Intense, squeezing, or constricting pain.
• Pain radiating to the neck, jaw, shoulders, shoulder blade.
• Nausea and/or vomiting.
• Cold sweats.
• Difficulty breathing.
1. First Aid for suspected heart attack:
a. Call EMS.
b. Advise the victim to stay calm.
c. Lie victim down with pillows or rolled
blanket behind his head and shoulders.d. If the victim has difficulty breathing, sit
him up.e. Loosen the victim’s clothing.
f. Provide ventilation.
g. Cover the victim if he or she is cold.
h. Monitor the ABCs
i. If breathing stops, initiate rescue breathing.
j. If pulse stops, initiate cardiopulmonary resuscitation (CPR).
2. There may be signs and symptoms of shock:
a. Restlessness or irritability.
b. Rapid, weak pulse.
c. Rapid breathing.
d. Pale or blue, cool, moist skin.
e. Excessive thirst.
f. Nausea and vomiting.
g. Drowsiness of loss of consciousness.
3. First Aid for shock:
a. Call EMS.
b. Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
c. Help the victim rest in order to reduce pain. Pain will make shock worse.
d. Keep the victim warm, with clothing or blankets.
e. Control any external bleeding.
f. Elevate the legs about 12 inches unless you suspect fractures of extremities.
g. Do not give the victim anything to drink or to eat.
h. Speak calmly and reassuringly to the victim.
11-1.16 Insects, Snakes, and Ticks
A. Insect stings are rarely fatal. However, if the victim has a severe allergy to the sting, a life threatening situation called anaphylaxis may develop.
B. Anaphylaxis:
1. Signs and symptoms of anaphylaxis:
a. Skin swells and turns red, or develops a rash.
b. Hives (welts), and itching
c. Nausea and vomiting.
d. Weakness and dizziness.
e. Difficulty breathing including coughing and wheezing, which may cause death.
2. First Aid for anaphylaxis:
a. Call EMS.
b. Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
c. The victim may carry an anaphylaxis kit. Follow instructions for injection.
C. Insect sting:
1. First Aid for insect stings:
a. Examine to see if the stinger is in the skin.
b. Scrape the stinger away from the skin with your fingernail or with a credit card.
c. In order to avoid further poisoning, do not remove the stinger with tweezers.
d. Wash the site with soap and water, then cover it.
e. Apply a cold pack to the site.
f. Monitor the ABCs.
D. Spider or scorpion bites:
1. Signs and symptoms of spider or scorpion bites:
a. Severe pain in the area of the bite.
b. Swelling in the area of the bite.
c. Nausea and vomiting.
d. Difficulty swallowing.
e. Difficulty breathing.
f. Irregular pulse, leading to cardiac arrest.
2. First Aid for spider or scorpion bites:
a. Call EMS.
b. Wash the site.
c. Apply a cold pack to the site.
d. Immobilize the affected part.
e. Keep affected part lower than the heart. This reduces blood flow to the body.
f. If a suction kit for snakebite is available, use it.
g. Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
h. The victim may carry an anaphylaxis kit. Follow instructions for injection.
E. Snakebite (rattlesnakes, water moccasins, copperheads):
1. Signs and symptoms of snakebite:
a. Severe burning at the site.
b. Rapidly spreading swelling.
c. Black and blue marks.
d. Fluid oozing from fang marks.
e. Fever.
f. Nausea and vomiting.
g. Bleeding from the mouth and the rectum.
h. Muscle cramps.
i. Disorientation.
j. Convulsions.
k. Shock, and collapse of the circulatory system.
2. Signs and symptoms of snakebite (coral snakes):
a. Little pain and swelling.
b. Multiple fang marks.
c. Paralysis of voluntary muscles (leg, arm, head movements).
d. Paralysis of involuntary muscles (swallowing, breathing, digestion).
e. Slurred speech.
f. Coma.
g. Collapse of the respiratory (breathing) system.
3. First Aid for snakebite
(All types of poisonous snakes):a. Call EMS.
b. Wash the wound.
c. Immobilize the affected part.
d. Keep affected part lower than the heart. This reduces blood flow to the body.
e. If a suction kit for snakebite is available, use it.
f. Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
g. Do not cut the wound.
h. Do not apply a tourniquet.
i. Do not use electric shock.
j. Do not apply ice.
F. Ticks are usually only a nuisance; most do not carry disease. However, Lyme disease and Rocky Mountain Spotted Fever are serious, but preventable bacterial infections carried by ticks. Rocky Mountain Spotted Fever causes death in one out of every five patients if untreated, and Lyme disease causes facial paralysis, aseptic meningitis (inflammation of the brain linings), cardiac abnormalities, and pains and swelling in the large joints. Both diseases can be treated with antibiotics if recognized early.
1. Signs and symptoms of Lyme disease:
a. Small, painless, occasionally itchy red area which slowly expands.
b. Red rim with clear center or,
c. a uniform red area or,
d. a bull’s eye.
e. The red area may expand to encompass the entire torso, arm, or leg.
f. Flu-like symptoms such as fever, headache, and fatigue.
g. Nervous system involvement, including meningitis (inflammation of the sheaths of the brain and spinal cord), encephalitis (inflammation of brain tissue) or facial palsy (paralysis of the face).
h. Heart block (abnormal slowing of the heart beat) causing dizziness or fainting.
i. Arthritis (pain in the joints) may develop months or years later.
2. Signs and symptoms of Rocky Mountain Spotted Fever:
a. High fever, chills.
b. Headache.
c. Severe fatigue.
d. Generalized skin rash especially on the extremities, palms and soles (the rash is usually in the form of reddish spots which may be raised above the skin surface).
3. First Aid for tick bites: Preventing bites is very important.
a. Avoid heavily infested areas especially near water or woods.
b. Wear closed shoes and pull socks over pant legs.
c. Be aware of ticks crawling on the packing mat.
d. Don’t leave jumpsuits or other clothing lying on the ground.
e. Inspect yourself or others for ticks.
f. Shower and wash clothes as soon as possible.
g. DEET in tick/insect repellent can help, but follow directions carefully.
h. Check your pets. Flea and tick collars may help.
4. If you find a tick:
a. Use tweezers to grasp the tick’s mouth as close to your skin as possible.
b. If necessary, use a glove, plastic wrap, a piece of paper, or a leaf.
c. Pull steadily and firmly until it lets go.
d. Apply antiseptic.
e. Place tick in alcohol to kill and preserve it for later identification.
f. Wash your hands immediately.
g. See a physician as soon as possible.
h. Do not try to burn the tick.
i. Do not coat the tick in vaseline or nail polish.
11-1.17 Poisons
A. When a vehicle such as an automobile or an airplane is involved, there is a possibility that the victim could have inhaled carbon monoxide.
1. Signs and symptoms of ingested or inhaled poisons:
a. Different breath odor.
b. Dizziness.
c. Headache.
d. Irritability.
e. Difficulty breathing.
f. Nausea and/or vomiting.
g. Diarrhea.
h. Fainting.
i. Pale color of skin.
j. Pale, blue, or bright red lips
k. Burns around the lips or tongue if poison was ingested.
l. Unconsciousness.
2. First Aid for poisoning:
a. Be sure it is safe to enter the scene.
b. Try to identify the source of the poisoning.
c. Remove the victim from the source of
poisoning.d. Shut off any open source of poisoning, such as a car or airplane engine.
e. If the victim is in an enclosed area, quickly open all windows and doors.
f. If the victim ingested a poison, call the Poison Control Center.
g. Do not induce vomiting unless so directed by the Poison Control Center.
h. Do not give the victim anything to eat or to drink.
i. If the victim has a convulsion, see convulsions.
j. If the victim has burn, see burns.
k. Monitor the ABCs. If the victim is not breathing, initiate rescue breathing. If there is no pulse, initiate cardiopulmonary resuscitation (CPR).
First Aid Kit
A First Aid kit should contain the following items:
• Adhesive tape (1 inch)
• Antacids (Gelusil, maalox)
• Antihistamines (benadryl)
• Acetaminophen (tylenol)
• Betadine or other sterilizing solution
• Calamine lotion
• Cold pack
• Cotton swabs
• Elastic bandage (3 inch)
• Insect and snake bite kit
• Petroleum jelly (vaseline)
• Pocket mask (for CPR)
• Rubbing alcohol
• Scissors
• Soap (without deodorant or cold cream)
• Smelling salts (ammonia capsules)
• Splinting material
• Sterile gauze bandage (3 inch)
• Sterile gauze pads (4 x 4 inches)
• Sugar sweetened drinks
• Syrup of ipecac
• Thermal blanket
• Thermometer
• Topical antibiotic ointment
(bacitracin, neosporin, triple-A)• Tweezers
• Wire cutters
Everyone should know where it is located, and what its contents are.
1. Why should you check a victim’s vital signs?
a. To check for broken bones.
b. To check for bleeding.
c. To check for life threatening conditions.
d. To get some secret from the victim.
2. How will you first attempt to stop bleeding?
a. Elevate the injured part.
b. Apply direct pressure.
c. Use tissues to soak up blood.
d. Use a tourniquet.
3. When is it appropriate to call EMS?
a. After a complete physical examination.
b. As soon as the emergency occurred.
c. After you have the situation under control.
d. After you have determined that the victim is not responsive.
4. Why do you elevate the legs of a person who is in shock?
a. To make the victim more comfortable.
b. To improve circulation to the vital organs, especially the brain.
c. To start rescue breathing and CPR.
d. For easier transportation.
5. The adult CPR cycle consist of:
a. 10 chest compressions and 2 breaths.
b. 10 chest compressions and 1 breath.
c. 15 chest compressions and 2 breaths.
d. 15 chest compressions and 1 breath.
6. You have established that an adult victim is not breathing. You initiate rescue breathing, trying to give 2 full breaths, but they do not go in. What do you do next?
a. Do a finger sweep.
b. Retilt the head.
c. Initiate chest compressions.
d. Give up and wait for EMS.
7. A tree landing ended with the skydiver’s getting out of his harness and jumping off the tree. On landing, he hurt his ankle. You are not sure if the ankle is broken.
a. You put some cold compresses around the ankle.
b. Let the victim walk on it and then make your decision.
c. Care for the ankle as if it is broken.
d. Bandage loosely and elevate ankle.
8. A foreign object (piece of gravel) in a jumper’s eye remains despite repeated rinsing. Your next step is to:
a. Get pliers to remove the object.
b. Have the jumper close both eyes, and take him to a hospital, or call EMS.
c. Put a sterile bandage over the injured eye and wait for improvement.
d. Apply eye drops only.
9. How do you position someone with a severe nose bleed?
a. Sitting erect with head leaning back.
b. Lying down on back.
c. Sitting erect with head angled slightly forward.
d. Lying down on stomach.
10. You have to treat a burn on someone’s forearm that has charred edges, open blisters and is oozing.
a. Immediately call EMS and immerse the arm in cold water.
b. Immediately call EMS and place arm in ice box.
c. Immediately call EMS, monitor ABCs and be prepared to care for shock.
d. Immediately call EMS and put ointment on affected area.
11. What do you advise a fellow jumper who has heat exhaustion?
a. Get her in a cool area, have her drink lots of water if conscious, and let her rest.
b. Get her in a cool area, rub her down with ice or cloth soaked in ice water.
c. To lay down for rescue breathing.
d. To eat a lot of food and then to run it off by jogging.
12. What are the possible symptoms of an allergic reaction to a insect bite?
a. Difficulty breathing.
b. Insane behavior.
c. Bulging of eyes.
d. Loss of hair.
13. You have to move a victim who has a possible neck/spine injury. How would you do it, if you are alone?
a. Drag the victim by his legs.
b. Use clothes drag.
c. Keeping the head straight, pull victim by hair.
d. Use 2-handed seat carry.
14. What are some basic principles you consider when treating fractures?
a. Immobilize limb, apply very tight bandage to slow circulation.
b. Immobilize limb, apply snug bandage that allows circulation.
c. Immobilize limb, apply bandage right on top of fracture.
d. None of the above.
15. You come to a scene of an emergency. What is the first of your concerns?
a. How many victims need CPR?
b. How many victims need rescue breathing?
c. Is it safe to help?
d. Do you have enough bandages?
16. You suspect a person may have sustained an abdominal injury. Identify the possible symptoms and actions appropriate in this situation.
a. Symptoms: Rigid abdomen and pain, rapid breathing, excessive thirst.
Actions: Call EMS; do not give anything to eat or drink, elevate knees to relax abdominal muscles.
b. Symptoms: Hysteria, soft abdomen, numbness in abdomen.
Actions: Call EMS, administer an antacid.
c. Symptoms: Loss of consciousness, anxiety, excessive thirst.
Actions: Call EMS, give the victim little sips of water to drink and continue monitoring victim
d. Symptoms: Delirium, rapid pulse, vomit con- taining no blood.
Actions: Call EMS, and do not attempt to give Rescue Breathing.
17. How many breaths per second are given in Rescue Breathing for an adult?
a. 2 breaths every 5 seconds
b. 1 breath every 5 seconds
c. 2 breaths every 15 seconds
d. 1 breath every 15 seconds
18. A person is clutching her throat and making wheezing sounds.
a. Pat the person on her back and reassure the victim that all will be O.K.
b. Ask the person for permission to engage in abdominal thrusts. Give upward thrusts until object is dislodged, or EMS personnel arrives.
c. Ask the person for permission to engage in abdominal thrusts. Give upward thrusts. If person becomes unconscious, stop and attempt rescue breathing, even if breaths will not go in.
d. Ask the person for permission to engage in abdominal thrusts. Give 4-6 upward thrusts, and if by then the object does not come out, give up and call EMS.
19. How do you handle someone who is having a seizure?
a. Place something rigid between the victim’s teeth.
b. Hold victim still.
c. Clear area of harmful objects.
d. Call EMS and restrain at all cost.
20. What are some symptoms of a head injury?
a. Unequal size of pupils that do not respond by constriction to light stimulation.
b. Clear fluid oozing out of ear.
c. Victim is disoriented and speech is slurred.
d. All of the above.
21. How do you treat frostbite?
a. Rub area with snow.
b. Give victim alcohol to drink to warm him up.
c. Soak area in warm water, do not allow victim to smoke or drink.
d. None of the above.
22. How will you remove and then handle a tick?
a. Remove with tweezers only, and coat tick in vaseline.
b. Remove with anything but hands, and coat tick in nail polish.
c. Remove with anything but hands, and place tick in alcohol.
d. Remove with tweezers only, and burn the tick.
23. What are some of the symptoms and treatments of a chest injury?
a. Symptoms: Hissing sound, loud grunting breathing.
Treatment: Cover entire wound with anything available.
b. Symptoms: Rapid breathing, pale blue skin.
Treatment: Remove protruding object, and keep victim warm.
c. Symptoms: Head ache, heart ache.
Treatment: Tell the victim to stop drinking and dump boyfriend.
d. Symptoms: Vomiting, excessive thirst.
Treatment: Give victim water, and monitor vital signs.
24. A person got bitten by a snake. How will you provide first aid?
a. Call EMS, cut the wound open and suck out venom.
b. Call EMS, put tourniquet on and monitor vital signs.
c. Call EMS, keep affected part lower than heart, use snake bite kit if available.
d. Call EMS, apply ice and use electric shock to cauterize area.
25. What are the some of the allergic reactions to an insect bite?
a. Swelling of skin, respiratory arrest
b. Blue stains on skin, and local swelling
c. Two little holes, especially in neck area
d. Delirium, high fever, and head aches