LKP Medica English Jakarta

LKP
MEDICA ENGLISH JAKARTA
1
Preface
This is a section handbook of Basic Life Support (BLS) that describe about how to give
first aid in medical emergencies and this course is based on the Standards and Guidelines
established by the 2017 National Conference on Cardiopulmonary Resuscitation and Emergency
Cardiac Care and on information provided by the Division of Medical Sciences, National
Academy of Sciences, National Research Council.
The course and this workbook are product of the 2015-2017 CPR/First Aid Project at
American Red Cross national headquarters. They have been designed to meet the requirements of
nurses.
Throughout this course, you are going to learn how important it is for you and your
community’s EMS system to work together in order to give the victim of a medical Emergency the
best chance of survival.
By taking this course, you are showing your commitment to know what to do in an emergency
and you have already taken one step to improve the ability of your community’s EMS system to
save lives. When you learn the information and skills presented in the course, you will be able to
put your caring and concern for others into action.
NURSING Division
Printed in Jakarta 2020
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Contents
Topic Page
Preface …………….………………………………………………………… 1
Contents ……………………………………………………………………. 2
Unit 1: Emergency Action Principles (E.A.P) ……………………………… 3
Unit 2: Rescue Breathing (R.B) …………………………………………….. 14
Unit 3: Heart Attack, Cardiac Arrest, CPR ..……………………………….. 22
Unit 4: Choking ........................................….……… …………….……….. 33
Unit 5: Bleeding and Shock …………………………………….................... 40
Unit 6: Poisoning ..………………….. .…….……………………………… 51
Unit 7: Burns …………………….…………………….…………………… 55
Unit 8: Temperature Extremes………….…………………………………… 59
Unit 9: Fractures, Dislocations, Sprains, Strains …………………………… 64
Unit 10: Eye and Nose Injuries ..…………………………………………… 72
Unit 11: Diabetic Emergencies ..................................................................... 75
Unit 12: Bites and Stings …………………………………………………... 77
Unit 13: Seizures ........................................................................................... 81
Unit 14: Stroke .............................................................................................. 83
Unit 15: First Aid and Infectious Diseases ..……………………………….. 85
Unit 16: Rescues ............................................................................................ 87
References ..................................................................................................... 89
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Unit 1: Emergency Action Principles
Learning Objectives First aid, properly given, can reduce the effects of injuries and medical
emergencies, can keep a seriously ill or injured person alive. Proper first
aid must be given quickly and effectively or the victim’s condition may
In this unit you will learn how to; become more serious by the time further help arrives on the scene.
1. Survey the scene In the excitement of an emergency, it is important to stop for a
2. Do a primary survey of the moment to clear your head and think before you act. When responding to
victim an emergency situation, remain calm and apply the four emergency action
3. Phone the emergency principles:
medical services (EMS) 1. Survey the scene.
system for help 2. Do a primary survey of the victim.
4. Do a secondary survey of the 3. Phone the emergency medical services (EMS) system for help.
victim 4. Do a secondary survey of the victim.
A. Survey the Scene

When you respond in an emergency, make a quick, decision-making
survey of the entire scene. Don’t look only at the victim; look at the area
around the victim. This should take only a few seconds. Decide what
needs to be done immediately and in which you will take other steps.
Consider the following as you do your survey:
1. Is the scene safe?

You must first decide if the situation is safe for you. You cannot
help the victim by becoming a victim yourself. Know your
abilities. If you cannot get to the victim because of extreme
hazards, such as fire, toxic fumes, heavy traffic, electrical wires,
or deep or swift-moving water, call EMS. In addition to sending
medical care, the EMS dispatcher can contact the fire
department, police department, park rangers, lifeguards, Power
Company, or other services needed to handle the specific life-
threatening hazard.
If you can safely get to the victim, decide if it is safe to
remain at the scene while you continue the steps of the
emergency action principles and care for the victim. If it is not
safe, you may need to make an immediate emergency rescue. As
a general rule, however, do not move an injured person if you do
not have to.
2. What happened?
If the victim is conscious, ask specific questions to determine
what happened and the extent of the victim’s illness or injury. If
the victim is unconscious and you are unable to determine what
caused the illness or injury, the look around for clues. The scene
itself often gives the answers (Fig. 1).
If a person is lying next to a ladder, you may suspect that he or she

fell off the ladder and may have broken bones and bruises. An
electrical wire on the ground at the scene may mean that the victim has
suffered an electric shock. This kind of information is important,
especially when the victim is unconscious and cannot tell you what is
wrong.
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Quickly look for a medical alert tag at the neck or wrist. If the victim is not responsive, this tag may
provide some information about what might be wrong and how you should care for him or her.
Some accidents may cause head, neck, or back injuries that, if not treated properly, could lead to
permanent paralysis or even death. Any victim who complains of pain in the head, neck, or back, or is found
unconscious after an accident, must be cared for as if he or she has a spinal (neck or back) injury. At the
scene of this type of injury, you might find clues such as a car with a shattered windshield, scaffolding that
has collapsed, cuts, bleeding from the ears or nose, or bruises on the victim’s head, neck, or face that are
indicators of possible spinal injuries.
3. How many People are injured?

Look beyond the victim you see at first glance. There may be other victims. One person may be screaming
while another, who may be more seriously injured or unconscious, is unnoticed. In an auto accident, car
doors that are open may mean there are more victims nearby who were thrown from or walked away from
the car.
4. Are there bystanders who can help?

If there are bystanders, use them to help you find out what happened. If anyone knows the victim, ask if the
victim has any medical problems. This information can help you determine what may be wrong.
Bystanders, although they may not be trained in first aid, can help you in other important ways, such as by
calling EMS; by offering emotional support to the victims, their friends, and their families; and by keeping
onlookers from getting too close to the scene.
5. Identify Yourself as a Person Trained in First Aid

Tell the victim and bystanders who you are and that you are trained in first aid. This may help to reassure
the victim. It will also help you take charge of the situation, letting others who may have been caring for the
victim knows that a trained person is on hand.
Before giving first aid to a conscious victim, it is important that you obtain his or her consent. Consent
should be obtained from all mentally competent, conscious adults. Asking for consent is a matter of a
simple question. Say, “Hi, my name is ……………… I know first aid and I can help you until an
ambulance arrives; is that OK?” For minors and mentally or emotionally disturbed victims, make a
reasonable attempt to get permission from a parent or legal guardian. If a parent or guardian is not
available, first aid care may be given without consent. If a victim is unconscious, badly injured, or so ill
that he or she cannot respond, consent is implied. The law assumes that consent would have been given.
Figure 1: Survey the Scene
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B. Do a Primary Survey of the Victim
The purpose of a primary survey is to check for life-threatening conditions and to give urgent first aid care.
When you come upon the scene of an accident that you did not witness, you may find a victim who is not
moving. You must determine whether the victim is conscious and responsive or is unconscious. You can generally
tell if the person is responsive by gently tapping the person on the shoulder and asking, “Are you OK?”
Some injuries or illnesses may require assistance in caring for the victim or calling EMS. If this is the case, you
may need to shout several times to get someone’s attention. While you are seeking help, continue the primary survey
by checking for Circulation (pulse and severe bleeding) Airway, and Breathing. This is known as checking the
CAB:
Circulation:
1. Is the person’s heart beating? (Does the person have a pulse?) To check to see if the victim’s heart is
beating you will learn to feel for a pulse at the side of the neck. This pulse is called the carotid pulse
(Fig.2).
2. Is the person bleeding severely? To check for bleeding, feel and look over the victim’s body quickly for
wet and blood-soaked clothing to determine if it is severe. “Severe bleeding” is arterial bleeding
____bleeding that spurts from a wound with every beat of the heart _____ and must be controlled
immediately (Fig. 3).
Airway:
Does the victim have an open airway? The most important action for successful resuscitation is to immediately open
an unconscious victim’s airway using the head-tilt-chin lift (jaw support) method (Fig. 4). It opens the airway by
moving the tongue away from the back of the throat.
Breathing:
Check for breathlessness. (Is the person breathing?). Look for the chest to rise and fall, listen for breathing, and feel
for air coming out of the victim’s nose and mouth (Fig. 5).
Figure 2: Locate & feel Carotid Figure 3: Severe Bleeding Figure 4: Head-tilt/Chin-lift Figure 5: Check for breathlessness
pulse
C. Phone the Emergency Medical Services (EMS) for Help

Make the call to EMS yourself (Fig. 6), or give that responsibility to bystanders. If possible, two people to make the
call, to ensure it is made accurately. Instruct the caller(s) to tell you what the dispatcher said. Make sure that the
dispatcher has all the information to get the right help to the scene quickly. Be prepared to tell the dispatcher;
 The location of the emergency (exact address, city or town, nearby intersections, landmarks, name of
building, floor, apartment or room number).
 What has happened?
 The number of victims.
 The victim’s conditions.
 The help being given.
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D. Do a Secondary Survey of the Victim
The purpose of a secondary survey is to check the victim carefully and in an orderly way for injuries or other
problems that are not an immediate threat to life but which could cause problems if not corrected. For example, a
secondary survey may lead you to suspect that the victim has broken bone. This may not be immediately life-
threatening but could become a serious problem if ignored.
During a secondary survey, you look for important signs and symptoms of possible injury. A sign is what
your senses tell you about the victim’s condition – what you see, hear, felt, touch, and smell. A symptom is what the
victim tells you about his or her condition.
A secondary survey has three steps:

1. Interview the victim and/or bystanders.
2. Check the victim’s vital signs.
3. Do a head-to-toe exam.
If possible, you or a bystander should write down the information from a secondary survey. This will be helpful
to EMS later on.
Victim and Bystander Interviews
This first step in a secondary survey gives you important information about what happened to the victim. It helps you
determine what to look for while you complete the rest of the secondary survey.
Begin by identifying yourself as someone trained in first aid. Get the victim’s consent to give first aid, and
reassure him or her. Interview the victim first. Ask the victim his or her name and then use it. Build on what you
learned in the survey of the scene. What else can you find out about the injury or illness? Ask the victim specific
questions about how he or she feels. Ask if the victim has any pain or discomfort. Ask about any medical problems,
allergies, and medications.
After interviewing the victim, ask bystanders what they saw and what they know about the victim. If the victim
is unconscious, stay at his or her head to monitor the CAB. You can interview the bystanders from there.
The more you learn, the more you can help the victim and the more you can tell EMS about the illness or
injury.
Vital Signs
The second step of a secondary survey is to check the victim’s vital signs (pulse rate, breathing rate, and skin
appearance). These observations give you additional information about the victim’s condition. Recheck the vital
signs every five minutes while waiting for EMS, because any changes may be significant. Keep in mind the normal
adult ranges for this signs:
 Pulse rate: 60 to 80 beats per minute
 Breathing rate: 12 to 20 breaths per minute
 Skin appearance:
1. Temperature (warm, not hot or cold)
2. Moisture (not moist and not dry)
3. Skin color (face should be normal skin color, not pale or bluish).
Be especially alert for vital signs that indicate life-threatening conditions such as shock. These signs include –
 Very fast or very slow pulse rate.
 Very fast or very slow breathing.
 Cool, moist, and pale or bluish skin, lips, and fingernails.
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Head-to-Toe Exam
The final step of secondary survey is to do a head-to-toe exam. Tell the victim that you are going to check his or her
body for other injuries. Keep the victim still as you do the exam. Watch the victim’s facial expressions and listen for
changes in the tone of voice. If you touch something that hurts, the victim’s face or voice will often reflect the pain.
Do not apply pressure over any area the victim says is painful. Do not apply any pressure to the spine or to any soft
spots found on the head. Check for a medical alert tag at the neck or wrist. If the victim is not responsive, this tag
may provide some information about what might be wrong. Think about how a normal body looks and feels. Some
injuries make look or feel different. Think about how a normal body moves. Injuries may, for example, change how a
victim moves his or her fingers or toes, or may even keep the victim from moving them at all.
In the head-to-toe exam, you are looking for wounds, body fluids, deformities (such as bumps, depressions,
and body parts in unusual positions), and areas that are painful. Work carefully and in an orderly way.
Start at the head and neck all parts, the scalp, face, and sides of the head. Look at the pupils, which may tell you
something about the victim’s condition. If both pupils are larger than normal (dilated), the injury or illness may
involve shock, severe bleeding, heat exhaustion, or drugs such as cocaine or amphetamines. If both pupils are smaller
than normal (constricted), heat stroke or drugs such as narcotics might be involved. If the pupils are of unequal size,
suspect head injuries or a stroke. Check for fluid or blood in the ears, nose, and mouth. Run your hands gently down
the sides of the neck checking for pain or signs of injury while also looking for cuts or bruises.
Feel the collarbones. Run your hands along the chest to check the rib cage for pain or deformity. Press gently
on the victim’s abdomen. Pain could mean possible internal injuries. Now move to the shoulder, arms, and hands.
Move your hands down the arms to the fingers, one arm at a time. Ask the victim to wiggle his or her fingers.
Now move to the lower body. Begin by moving your hands over the hips. Then check the legs and feet in the
same manner as you did the arms and hands. Ask the victim to wiggle his or her toes.
It will take about 2 to 3 minutes to complete the head-to-toe exam. After you have finished, give first aid care
to the most serious injuries first.
Throughout the whole secondary survey, note any changes in the level of responsiveness, pulse, breathing, and
skin appearance.
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Emergency Action Priciples Action Guide
Survey the scene

Is it safe?
______________________________________
Yes No
Begin a primary survey Phone EMS
Tap and ask “ Are you OK? Stay clear of danger
Does victim respond ?
_____________________________________
Yes No
Identify yourself and get consent Shout “Help!”
Monitor CAB Is pulse present?
Is severe bleeding present?
_______________________ ______________________________________
Yes No Yes No
Phone EMS Phone EMS Monitor pulse Open airway
Control Bleeding Do a secondary Open airway Is breathing present?
Monitor CAB survey Is breathing present?
_____________________ __________________________
Yes No Yes No
Control any Do secondary survey Phone EMS Give 2 breaths
severe bleeding Begin ECC Does chest rise?
______________________
_________________________
Yes No Yes No
Phone EMS Do secondary survey Phone EMS Retilt head
Control Bleeding Begin CPR Give 2 breaths
Monitor CAB If chest still does
not rise, phone EMS
Begin first aid for

unconscious victim
, with airway obstruction
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Skill Sheets: Secondary Survey
You have already surveyed the scene, done a primary survey, and phoned
EMS. You are ready to begin a secondary survey of a conscious victim.
O O Interview the victim
Introduce yourself
Get permission to give care
Ask the victim’s name.
Ask, “What happened?”
Ask, “Do you have any pain or discomfort?”
Ask, Do you have any allergies?”
Ask, “Are you taking any medications?”
O O Check Vital Signs
Determine Radial or Carotid Pulse Rate.
Tell victim you are going to take his or her pulse.
Radial Pulse – Without moving the victim’s hand or arm, place your
index and middle fingers on palm side of victim’s wrist. Slide your
fingertips toward the thumb side of wrist. Apply moderate pressure.
Carotid Pulse – Locate Adam’s apple with middle and index

fingers of hand closer to victim’s feet. Slide fingers down into
groove of neck on side closer to you
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Figure Pulse Rate – Count the number of beats in 30 seconds. Multiply by
2. This is the number of heartbeats per minute.
Record pulse rate: ______________
Beats in 30 seconds x 2 = Beats per minute
Determine Breathing Rate.
Watch rise and fall of victim’s chest and abdomen.
Count number of breaths in 30 seconds. Multiply by 2. This is the number

of breaths per minute.
Record breathing rate: ____________________
Breaths in 30 seconds x 2 = Breaths per minute
Determine Skin Appearance.
Feel victim’s forehead with back of your hand.
Look at victim’s face and lips.
Record skin appearance:
Temperature ______________
Moisture _________________
Color ____________________
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O O Do the Head-to-Toe Exam.
Start with the head. Look and feel for cuts, bruises, and other signs of
injury.
Check and compare pupils of both eyes.
Check for fluid or blood in ears, nose, and mouth.
Gently feel the sides of the neck to check for pain and signs of injury.
Look for cuts or bruises.
Check and compare both collarbones and both shoulders for signs of
injury and pain.
Check the rib cage for pain or signs of injury by pressing firmly along
sides of chest.
Check victim’s abdomen for tenderness by pressing lightly with flat

part of your fingers. Check for bruises if possible.
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Check one arm at a time. Begin at the shoulder and move toward the
fingers. Ask the victim to wiggle his or her fingers, if not painful.
Press firmly on the hips. Look for signs of injury.
Check one leg at a time. Begin at the top of the leg and move toward the
foot. Ask the victim to wiggle toes or feet, if not painful.
Record Your Findings.

____________________________________________________________
____________________________________________________________
____________________________________________________________
Final instructor Check ________________________________________
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Unit 2: Rescue Breathing
Learning Objectives Definition
Rescue breathing is a way of breathing air into someone’s lungs when natural
In this unit you will learn how breathing has stopped or person cannot breathe properly on his or her own. This
to; is also known as artificial respiration or expired air resuscitation (EAR), is a
1. Recognize a breathing way of breathing air into someone to supply that person with the oxygen needed
emergency. for survival. EAR is given to victims who are not breathing but still have signs
2. Position a victim for rescue of circulation.
breathing.
3. Perform rescue breathing. Respiratory and Circulatory System
4. Recognize a breathing
emergency with gastric The pathway from the nose and mouth to the lungs is called the airway. For air
distention and vomiting. to enter the lungs, the airway must be open. Air contains oxygen, which the
5. Perform rescue breathing; body needs to live. In the lungs oxygen enters the blood. From the lungs the
mouth-to- nose and mouth- oxygen-filled blood is carried throughout the body by the circulatory system.
to-stoma breathing.
6. Recognize victim with Without a constant supply of oxygen, the brain will begin to die within
dentures four six minutes. Rescue breathing works because the air you breathe into the
7. Recognize victim with neck victim contains more than enough oxygen to keep that person alive. The air you
and back (spinal) injury take in with every breath is about 21% oxygen, but your body uses only a small
part of that. The air you breathe out of our own lungs and into the lungs of the
victim is about 16 % oxygen, enough oxygen to keep someone alive.
You will discover whether you need to give EAR during the first two
steps of the ABC in the primary survey when you open the airway and check for
breathing. If you can't see, hear, or feel any signs of breathing, you must begin
EAR immediately.
Common Cause of Breathing Emergencies
Breathing emergencies may be caused by:

 Poisonous substances.
 Airway obstructions
 Injury to the chest or lungs.
 Near-drowning.
 Electrocution.
 Certain drugs.
 Burns.
 Certain diseases and illnesses.
 Reaction insect bites and stings.
 Shock.
Do not stop Rescue Breathing or EAR unless on of the following occurs:
 The victim begins to breathe unaided / shows signs of life.

 The victim has no signs of circulation. If so, begin CPR.
 Another first aider takes over for you.
 Emergency personnel arrive on the scene and take over.
 You or rescuers are physically unable to continue.
 An AED is ready to use
 The scene becomes unsafe
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If the victim is not breathing but has a pulse, begin rescue breathing. To
give rescue breathing keep the airway open with the head-tilt/chin-lift. Then
give one breath every 5 seconds. Each breath should last 1 second. After 2
minutes recheck the carotid pulse. Then continue giving one breath every 5
seconds. These steps keep air flowing to the victim’s lungs.
Refer to the skill sheets for the step-by-step procedure for giving rescue
breathing.
Common Question in Rescue Breathing
1. Why was the technique for opening the airway changed from the neck-
lift to the chin-lift method?
2. Can a person be breathing and not have a pulse?
Answer
1. Lifting the chin instead of lifting from the back of the neck
minimizes further injury to the victim, especially if he or she is
suffering from a neck or back injury.
2. No. When the heart stops beating, blood no longer circulates

through the body, which deprives the cells of oxygen. This causes
the respiratory system to shut down and the person to stop
breathing.
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Rescue Breathing Skill Sheets
Skill Sheets: Rescue Breathing
Mouth-to-Mouth Method
You find a person lying on the ground, not moving. First survey the scene
to see if it is safe, and to get some idea of what has happened. Then do a
primary survey by checking for unresponsiveness, check circulation, open
airway, and breathing (C-A-B)
Note: Before you practice on a manikin, clean its face and the inside of its
mouth. Clean the manikin’s face and mouth before each person in your
group practices.
Check for Unresponsiveness (Does victim respond?)

Tap or gently shake victim.
Ask, “Are you OK?”
If no response, shout for help
Position the Victim
Carefully place the person on their back

Roll victim onto back, if necessary.
Kneel facing victim, midway between victim’s hip and
shoulders.
Straighten victim’s legs, if necessary, and move arm

closer to you above victim’s head.
Lean over victim, and place one hand on victim’sshoulder
and other hand on victim’s hip.
Roll victim toward you as a single unit: as you roll victim,

move your hand from shoulder to support back of head and
neck.
Place victim’s arm nearer you alongside victim’s body.
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Check for Carotid Pulse
Maintain head-tilt with one hand on victim’s forehead.
Locate Adam’s apple with middle and index fingers of other

hand.
Slide fingers down into groove of neck on side closer to you.
Feel for carotid pulse for no more than 10 seconds.
Say, “Has pulse.”
Open the Airway (Use head-tilt-chin lift method)
Place one hand on the top of the head and tilt the head back.
Support the jaw with your fingers in a "pistol grip position

.
Tilt the head and lift the jaw. Avoid closing victim’s mouth
and look in the mouth for any obstructions.
Check for Breathing
Look, listen, and feel for breathing for 3 to 5 seconds
Say, “No breathing but there is a pulse.”
. Phone EMS for Help and get an AED if available
Tell someone to call for an ambulance
Say, “has no breathing but has pulse, call________”

(Local emergency number or Operator).
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Begin Rescue Breathing
Maintain open airway with head-tilt/chin lift.

Pinch nose shut.
Open your mouth wide, take a deep breath, and
make a tight seal (or seal with the mask if available)
around outside of victim’s mouth
Give 1 breath every 5 seconds.
Each breath should last 1 second and make the chest rise
and fall. Count aloud:
“one one-thousand, two one-thousand, three one-thousand,
four one-thousand,”. Take a breath yourself and breathe into
the victim. Continue for 2 minutes
Recheck Carotid Pulse
Locate carotid pulse and feel no more than 10 seconds.

Check for Breathing
Say, “No breathing.”
What To Do Next
If pulse is absent, begin CPR.

If pulse is present but victim still not breathing,
continue rescue breathing.
If victim begins to breath, maintain open airway,
and monitor breathing until EMS arrives.
Final Instructor Check _____________________
18
Rescue Breathing With Special Situations
Air in the Stomach (Gastric Distention)

While doing rescue breathing, be careful not breathe air into the victim’s
stomach. Air in the stomach can be a serious problem. It can cause the victim to
vomit. When an unconscious person vomits, the stomach contents may go into
the lungs. That can lead to death.
During rescue breathing, air can enter the stomach in three ways:
 Breathing into the victim after the chest has risen. This causes extra air
to fill the stomach.
 Not tilting the victim’s head back far enough to open the airway
completely and then breathing at greater pressure to fill the victim’s
lungs.
 Giving breaths too quickly. Quick breaths are given with higher
pressure, which causes air to enter the stomach.
To avoid forcing air into the stomach, make sure you keep the victim’s head
tilted all the way back. Breathe into the victim only enough to make the chest
rise. Don’t give breaths too quickly; pause between breaths long enough to let
the victim’ lungs empty and for you to get another breath
If you notice that the victim’s stomach has begun to bulge, makes sure that
the head is tilted back far enough and make sure you are not breathing into the
victim too hard or too fast.
Vomiting
Sometimes while you are helping an unconscious victim, the victim may vomit.
If this happens, turn the victim’s head and body to one side, quickly wipe the
material out of the victim’s mouth, and continue where you left off.
Mouth-to-Nose Breathing
Use the mouth-to-nose breathing method when the victim’s mouth or jaw is
injured, the victim is bleeding from the mouth, the jaw cannot be opened, or if
your mouth is too small to make a tight seal. Mouth-to-nose breathing should be
done as follows:
 Maintain the backward head-tilt position with one hand on the

forehead. Use the other hand to close the mouth and lift the chin.
 Open your mouth wide, take a deep breath, seal your mouth tightly
Figure 6: Mouth-to-Nose around the victim’s nose, and breathe full breaths into the victim’s nose
Breathing (Fig. 6), as described for the mouth-to-mouth method in the skill sheet.
Open the victim’s mouth between breaths, if possible, to allow air to
come out.
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Mouth-to-Stoma Breathing
There are some people who have had surgery to remove all or part of the upper
end of the windpipe. They breathe through an opening called a stoma in the
front of the neck (Fig. 7). This takes the air right into the windpipe, bypassing
both the mouth and nose.
To give rescue breathing to someone with stoma, you must give breaths
through the stoma and not through the mouth or nose. In mouth-to-stoma
breathing, you follow the same basic steps as in the mouth-to-mouth method,
except that you:
1. Look, listen, and feel for breathing with your ear held over the stoma.
2. Give breaths into the stoma, breathing at the same rate as for mouth-to-
mouth breathing (Fig. 8).
Figure 7: Victim with a Stoma
There are several other important things you should remember when you
give rescue breathing to some one who breathes through a stoma:
 Don’t tilt the victim’s head back.
 Don’t breathe air into the victim through his or her nose or mouth. This
may fill the victim’s stomach with air.
 Never block the stoma, since it is the only way the victim has to breathe.
 In some instances a person who has had only part of the upper end of his or
her windpipe removed may breathe through the stoma as well as the nose
and mouth. If the person’s chest does not rise when you breathe through the
stoma, you should close off the mouth and nose and continue breathing
through the stoma.
Victims with Dentures

If a victim who needs rescue breathing is wearing dentures, leave the dentures in
place if they have not moved. They will give support to the mouth and cheeks
during mouth-to-mouth breathing. Even if the dentures are loose, the head-
tilt/chin-lift described earlier may help keep them in place. If the dentures
become so loose that they block the airway or make it difficult for you to give
breaths, take them out.
When Neck and Back (Spinal) Injuries Are

Suspected
Figure 8: Mouth-to-Stoma
Breathing
Most conditions requiring rescue breathing (or CPR) are not due to or associated
with major injuries. However, a small number of the victims who require rescue
breathing (or CPR) may have received a serious injury to the head, neck, or
back. Moving these victims, or opening the airway as described in the skill
sheets, may lead to further injury.
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Rescue Breathing Action Guide
Survey the scene

Begin a primary survey
Tap and ask “ Are you OK?
______________________________________________
Yes No
________________________ ________________________________
Yes No Yes No
_____________________ __________________
Yes No Yes No
Control any Phone EMS Phone EMS Give 2 breaths
severe bleeding Begin Rescue breathing Begin ECC Does chest rise?
Is severe bleeding present? Give one breath every 5
Seconds each breath
Should last one second ____________________
_________________________
Yes No
Yes No
Control Bleeding Begin CPR Give 2 breaths
Monitor CAB If chest still does
not rise, phone EMS
Begin first aid for
unconscious victim
, with airway obstruction
21
Unit 3: Heart Attack, Cardiac Arrest, and CPR
A heart attack happens when one or more of the blood vessels that supply
blood to a portion of the heart become blocked. When this happens, the
In this unit you will learn how to; blood cannot get through to feed that part of the heart and the cells begin
1. Recognize early warning to die. The heart may not be able to pump properly because part of is
symptoms of a heart attack. dying.
2. Perform first aid for a heart If a large part of the heart is not getting blood, the heart may not be
attack. able to pump at all. If the heart stops, the victim is in cardiac arrest; and
3. Recognize a cardiac arrest cardiopulmonary resuscitation (CPR___ a combination of chest
emergency. compressions and rescue breathing) must be started immediately.
4. Perform CPR Since any heart attack may lead to cardiac arrest, it is important to be
(cardiopulmonary able to recognize when someone is having a heart attack. Prompt action
resuscitation) may prevent the victim’s heart from stopping. A heart attack victim
whose heart has stopped. Most people who die from a heart attack die
within 2 hours after having the heart attack. Many of these people could
have been saved if the person having the heart attack, and the bystanders
had been able to recognize the signs and symptoms of a heart attack and
taken prompt action.
Signs and Symptoms

The most significant sign of a heart attack is chest discomfort or pain.
A victim may describe it as uncomfortable pressure, squeezing, a fullness
or tightness, aching, crushing, constricting, oppressive, or heavy. The pain
is described as being in the center of the chest behind the breastbone. The
pain may spread to one or both shoulders or arms or to the neck, jaw, or
back (Fig. 9).
In addition to chest pain, other signs and symptoms may include____

 Sweating.
 Nausea.
Figure 9: Area for Heart Attack Pain
 Shortness of breath.
First Aid for a Heart Attack

A quick response in case of heart attack requires that you;
1. Recognize the signs and symptoms of a heart attack and take
action.
2. Have the victim stop what he or she is doing and sit or lie down
in a comfortable position. Loosen restrictive clothing. Do not let
the victim move around.
3. Have someone phone EMS for help. If you are alone, make the
call yourself.
A key factor in whether or not a victim will survive a heart attack is

how quickly the victim receives advanced care. Therefore, it is important
to call EMS right away before the condition gets worse and the heart
stops.
22
How Heart Attacks Happen CPR---First Aid for Cardiac Arrest
If the heart does stop (cardiac arrest), the appropriate first aid begins
While heart attacks seem to strike suddenly, the
conditions that often cause them may build up with cardiopulmonary resuscitation (CPR). Cardio refers to the heart,
silently for years. Most heart attacks are the and pulmonary refers to the lungs. So cardiopulmonary resuscitation
result of cardiovascular disease. means resuscitation of the heart and lungs. CPR is a combination of chest
Cardiovascular disease happens when fatty
compressions and rescue breathing.
substances and other materials build up in the
blood and begin to stick to the walls of the
blood vessels. To help a person in cardiac arrest, you must provide CPR. CPR has
Over time, the blood vessels get narrower. As two purposes. By breathing into the victim and compressing the chest,
the blood vessels get narrower, it becomes more
you;
and more likely deal a blood vessel in the heart
will become partly or completely clogged. This * Keep the lungs supplied with oxygen when breathing has stopped.
process can begin early in life; it may even * Keep blood circulating and carrying oxygen to the brain, heart,
begin in early childhood. and other parts of the body.
Cardiovascular disease may only be stopped
or slowed by certain changes in the way you
live. This disease cannot be stopped by All of your body’s living cells need a steady supply of oxygen to keep
medicines, though some related problems (like you alive. CPR must be started as soon as possible after the heart stops.
high blood pressure) can be controlled or Any delay in starting CPR reduces the chances that EMS personnel will be
slowed by medicines.
able to restart the heart. In addition, the brain cells begin to die after 4 to 6
Risk Factor for Heart Disease minutes without oxygen.
Scientists have been able to identify certain The Technique

things that are related to getting cardiovascular
disease. They call these risk factors; some can
be changed while others cannot. To find out if a person needs CPR, begin with survey the scene to do
CAB. The skill sheets that follow provide t+he step-by-step procedure for
Risk Factors That You Cannot Change giving CPR by using The 3 C’s of CPR; CHECK – CALL – CARE.
 Heredity (a history of cardiovascular
disease in your family) 1. Check for responsiveness ( no breath and no pulse)
 Sex (males are at a greater risk) Call EMS for help (get an AED if available)
 Age (You are at greater risk as you Compress Chest
get older) Deliver 30 compressions
Risk Factors That You Can Change
Place of both hands at centre of chest
Rate of 120 compressions per minute Depth of at least 2 inches
 Cigarette smoking Compress and releases in a steady rhythm
 High blood pressure 2. Airway, by using head tilt/chin lift method if no neck trauma
 High blood cholesterol (influenced suspected
by a diet high in saturated fat and
cholesterol)
 Uncontrolled diabetes
 Obesity (being overweight) 3. Rescue Breathing, deliver 2 breaths
 Lack of exercise About 1 second each rescue breath
 Stress Watch chest rise
Unfortunately, there is no quick fix for Continue 30 : 2 compressions to breath cycle
dealing with the risk of cardiovascular disease. 4. External Defibrillation, use of an AED (Automated External
Just reading the list won’t reduce your risk of Defibrillators) is a vital part of the lifesaving sequence
having a heart attack. Reducing your risk Know where the nearest AED is located
requires effort on your part and guidance from
you doctor or other health-care provider.
For effective compressions:
If you are interested in learning more about
how to reduce your risk of cardiovascular
- Push fast
disease, the American Red Cross can tell you - Push hard
about the available in your community to help - Allow chest to fully recoil.
you. - Minimize any interruptions
23
CPR Skill Sheets
You find a person lying on the ground, not moving. First, you should
survey the scene to see if it is safe, and to get some idea of what has
happened. Then do primary survey by checking for unresponsiveness,,
check circulation, open airway, and breathing (C-A-B)
Note: Before you practice on a manikin, clean its face and inside of its
mouth. Clean the manikin’s face and mouth before each person in you
group practices. Do not practice actual compressions on your partner---
only on a manikin.
Check for Unresponsiveness (Does victim respond?)

Tap or gently shake victim.
Shout, “Are you OK?”
If no response, shout, “Help!”
. Position the Victim
Carefully place the person on their back

Roll victim onto back, if necessary.
Kneel facing victim, midway between victim’s hip and
shoulders.
Straighten victim’s legs, if necessary, and move arm

closer to you above victim’s head.
Lean over victim, and place one hand on victim’sshoulder
and other hand on victim’s hip.
Roll victim toward you as a single unit: as you roll victim,

move your hand from shoulder to support back of head and
neck.
Place victim’s arm nearer you alongside victim’s body.
24
Check for Carotid Pulse
Locate Adam’s apple with middle and index fingers of other

hand.
Slide fingers down into groove of neck on side closer to you.
Feel for carotid pulse for no more than 10 seconds.
Say, “No pulse.”
Open the Airway (Use head-tilt-chin lift method)
Place one hand on the top of the head and tilt the head back.
Support the jaw with your fingers in a "pistol grip position

.
Tilt the head and lift the jaw. Avoid closing victim’s mouth
and look in the mouth for any obstructions.
Check for Breathing
Say, “No breathing and no pulse.”
. Phone EMS for Help and get an AED if available
Tell someone to call for an ambulance
Say, “has no breathing has no pulse, call________”

25
Locate Compression Position
Kneel, facing victim’s chest.
With middle and index fingers of hand nearer victim’s legs,locate

lower edge of victim’s rib cage on side closer to you
Slide finger up edge of rib cage to notch at lower end of

breastbone
Place middle finger in notch, and index finger next to it on the

lower and of breasbone.
Place heel of hand nearer victim’s head on brastbone next to

index finger of hand used to find notch
Place heel of hand used t locate notch directly on top of heel of

other hand
Keep fingers off victim chest
(Locate Compression Position; Second way:

Kneel, facing victim’s chest.
Place heel of hand in the center of the sternum (which is the
lower half of the sternum) and the heel of the other hand on
top of the first so that the hands are overlapped and parallel).
Position shoulders over hands, with elbows locked and arm

straight
26
Give 30 Chest Compressions
Give 30 chest compressions and 2 breaths at a rate of at least 120

chest compressions per minute, followed by opening the airway
and compress breastbone at least 2 inches
Count aloud, “1 and, 2 and, 3 and, 4 and, 5 and, 6 and, 7 and,

8 and, 9 and, 10 and 1 and ........” up to three times.
Compress down and up smoothly, keeping hand contact

with chest at all times.
(When giving chest compressions you are pressing with the heel of
your hand. You can interlace your fingers or place one hand on top
of the other)
Give 2 Full Breaths
Open airway with head-tilt/chin-lift.
Pinch nose shut.
Open your mouth wide, take a deep breath, and make a

tight seal around outside of victim’s mouth
Give 2 full breaths. Each breath should last about 1 second
Recheck Carotid Pulse
Locate carotid pulse and feel no more than 10 seconds.

27
Check for Breathing
Say, “No breathing.”
What To Do Next
Repeat cycles of 30 chest compressions and 2 breaths (use CAB-

Method) until help arrive or victim shows signs of life or an AED
arrives.
Final Instructor Check________________________________________
Common Question in CPR

1. Does the victim’s chest have to be bared to perform
compressions? How much should be uncovered?
2. Can or should you do CPR on someone who has a pacemaker?
3. When should you stop CPR?
Answer
1. It is not necessary to bare the chest if the victim’s clothing does not interfere
with finding the proper location for chest compressions. If there are several layers
of clothing, or if the clothing interferes with the performance of CPR, part of the
chest should be bared. If possible, do not bare the entire chest, since a relatively
small area is all that is needed for hand placement to give chest compressions.
Most importantly, do not waste time or delay compressions.
2. If a person’s heart has stopped beating (no carotid pulse), CPR is needed to
maintain blood circulation to the brain, heart, and other vital organs of the body.
This is true regardless of whether or not the person has a pacemaker. Because the
pacemaker is placed to the side of the heart and not directly below the breastbone,
it will not get in the way of chest compressions.
3. Stop CPR only if:

a. The heart starts beating again
b. A second rescuer trained in CPR takes over for you
c. EMS personnel arrive and take over.
d. You are too exhausted to continue
e. The person starts breathing normally
f. There is an automated external defibrillator (AED) to use
28
Heart Attack, Cardiac Arrest, and CPR Action Guide
Survey the scene

Tap and ask “ Are you OK?
_____________________________________
Yes No
____________________ ______________________________________
Yes No Yes No
_____________________ ____________________________
Yes No Yes No
Control any Do secondary survey Phone EMS Give 2 breaths
severe bleeding Begin ECC Does chest rise?
_______________________________
_________________________
Yes No Yes No
Control Bleeding Begin CPR cycle Give 2 breaths
Monitor CAB Give 30 chest compressions If chest still does
Giv e 2 breaths not rise, phone EMS
Repeat cycles 4 times Begin first aid for
in one minute unconscious victim
, Is pulse present? with airway obstruction
______________________________
Yes No
Is breathing present? Give 2 breaths
Repeat cycles 4 times
_____________________
Yes No
Monitor CAB Begin rescue breathing
29
USING AN AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
Automated external defibrillators (AEDs) are machines that are programmed to safely deliver an electrical shock
to a person who has collapsed from a heart problem. Each AED has instructions for that machine.
AEDs are often placed in public buildings in visible areas. Before an AED is used, all the steps for CPR
must be followed. The AED has a computer inside that will "speak" instructions for when to continue CPR and
when to check for a heart rhythm (pulse). The AED must be placed next to the person who has collapsed. Then it
must be turned on, and all the commands must be followed.
The Technique:
1. Turn on the AED. It will give you step-by-step instructions.
2. Wipe chest dry.
3. Attach the pads.
4. Plug in connector, if needed.
5. Make sure no one is touching the person.
6. Push the "Analyze" shock button if necessary.
7. If a shock is advised, push the "Shock" button.
8. Resume compressions and follow AED prompts.
Skill Sheet: One Rescuer CPR with an AED

First things, before you even consider using an AED, you need to be sure our environment is in such a
state that you can use an AED. In other words, there are no combustible gases or liquids and no standing water
that the body of the patient is laying in. If indeed you are by combustibles or you are in standing water you would
move the victim to a place of safety, dry them off so that you could literally use the AED on them. This is
specifically important around drowning patients. The body doesn't have to be completely dry, it's just that you
have to make sure we're not kneeling in a pool of water that the body of the patient is touching you might suffer
electrocution through that or have a shock. So, you're in a safe environment, the scene is safe, gloves are on, your
CPR shield is available. You start the same way.
O O Check for Unresponsiveness

Sir, are you okay? There's no response. The scene is safe, your
glove is on, your shield is available
He does not look like he is breathing or breathing normally,
immediately going call for EMS.
O O Phone EMS System for help.

You in the plaid shirt, go call EMS and return, you might need
your help.
Now that emergency medical services or a code has been called
we're going to go right into a pulse check.
O O Check Carotid pulse

check for a carotid pulse for no more than 10 seconds, you do not
feel a pulse.
O O Check for Breathing

The patient is not breathing. Now you are going to move right to
the AED. Turn it on.
30
O O Power on the AED
Check to make sure it is safe to use the AED. Unsafe condition
include victim in water, on metal surface, and flammable gas.
AED prompt- [This is a training device only, no shock will be

delivered]
O O Apply Pads
Peel off backing and place pads as the picture on the pads shows.
Press down firmly to assure pads are securely affixed.
I like to take the pads out and the scissors.

AED prompt- [Remove clothing from person's chest]
If it wasn't already cut we'd have to cut it, or rip it open.
AED prompt- [Attach pads firmly to person's chest, as shown]
There are diagrams on the pads, it's a nice idea to have a towel to
wipe off extra sweat, remove nitro glycerin pads or nicotine patches.
O O Plug in Connector
Follow AED directions. Some AED models have pre-
connector electrodes and will sense when pads are secure
AED prompt- [Check connector and pads]

Keep in mind that the pads will show you right on them with a diagram
as to where they go on the chest of the patient.
This one is going to go up here on the right top pectoralis region.
The second goes mid-axillary right underneath the arm pit on the left
side. Make sure the pads are sealed well. The connector only fits one
way on most AEDs.
O O Stand Clear
Don’t touch the victim while the AED is analyzing or charging.
AED prompt- [Analyzing rhythm, everyone stand clear]

you do not touching the patient, you do not kneeling on the patient.
AED prompt- [Shock advised, charging, everyone stand clear]
Make sure everyone's clear.
AED prompt- [Long Beep]
O O Push Shock Button

Shout, “clear,” and make sure no one is touching patient.
AED prompt- [Shock delivered, begin 5 cycles of CPR]
O O Give 30 Compressions
Give 5 cycles of 30 chest compressions, at a rate of at least 120
Compressions per minute, followed with 2 breaths with the head tilt
chin lift.
Doing this, 30 to 2. Until the AED interrupts you and then it will tell you
whether it is going to shock again.
Follow the prompts as you continue this rescue and wait for emergency
response to arrive. If for any reason the pads won't stick to the chest any
more you can remove them and try a new set of pads. However, if there
working.
31
We do not disconnect the AED until advanced life support or the next level of care comes and takes over.
O O After 2 Minutes
The AED will reanalyze. If AED says, “No shock advised,” continue CPR if no signs of life. Follow
AED prompts
*Begin Simulation*
1. Sir, sir are you okay? The scene is safe, my gloves are on, my shield is available. Sir can you hear me?
There's no response and he doesn't seem to be breathing or breathing normally.
2. You in the plaid shirt go call 911, please come back and let me know that they're on the way I don't
easily feel a pulse.
3. AED prompt- [This is a training device only, no shock will be delivered]
4. AED prompt- [Remove clothing from person's chest]
5. AED prompt- [Attach pads firmly to person's chest, as shown]
6. AED prompt- [Plug in connector]
7. AED prompt- [Check connector and pads]
8. AED prompt- [Analyzing rhythm, everyone stand clear]
9. AED prompt- [Shock advised.... Charging]
10. AED prompt- [Everyone stand clear]
11. AED prompt- [Long Beep]
12. [Shock delivered. Begin 5 cycles of CPR]
1 and, 2 and, 3 and, 4 and, 5 and, 6 and, 7 and, 8 and, 9 and, 10 and, 11 and, 12, and 13, 14, 15, 16, 17,
18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, and 30.
1 , 2 and, 3 and, 4 and, 5 and, 6 and, AED - [ one minute and thirty seconds of CPR remain....... ] 7
and, 8 and, 9 and, 10 and, 11 and, 12 and, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 24, 25, 26, 27, 28,
29, 30.
1 and, 2 and, 3 and, 4 and, 5 and, 6 and, 7 and, 8 and, 9 and, 10 and, 11 and, 12 and, 13, 14, 15, 16, 17,
18, 19, 20, 21, 22, 23 24, 25, 26, 27, 28, 29, 30.
AED Prompt- [One minute of CPR remain]
18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30.
AED prompt- [30 seconds of CPR remain......] 1 , 2 and, 3 and, 4 and, 5 and, 6 and, 7 and, 8 and, 9
and, 10 and, 11 and, 12 and, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 24, 25, 26, 27, 28, 29, 30.
18, 19, 20, 21 AED prompt- [Analyzing Rhythm]
AED prompt- [Everyone stand clear]
Do not touch patient.
AED prompt- [No shock advised, begin 5 cycles of CPR]
Adult AED Training Summary:

If the patient is a witnessed cardiac arrest, first check to assure the scene is safe. Check for patient responsiveness and
contact emergency services. Check for a pulse for no more than 10 seconds. Turn on the AED if the patient has no pulse
and is not breathing. Attach the AED pads to the patient, and do not touch the patient while the AED analyzes. After a
shock is delivered, begin CPR for about 5 cycles or two minutes. The AED will interrupt after two minutes and reanalyze
the patient. Continue to follow the AED's instructions until advanced life support arrives.
32
Unit 4: Choking
Choking, also known as airway obstruction, occurs when the airway becomes
blocked due to a solid object, fluids, or the back of the tongue. A person who is
In this unit you will learn how choking may quickly stop breathing and lose consciousness.
to:
1. Recognize when a
person has an airway Common Causes
obstruction. The most common causes of choking are:
2. Perform first aid for a  Trying to swallow large pieces of food that are poorly chewed.
conscious victim with  Drinking alcohol before or during eating. (Alcohol dulls the nerves that
an airway obstruction. help you swallow).
3. Perform first aid for an  Wearing dentures. Dentures make it difficult to sense the size of food
unconscious victim with when chewing and swallowing.
an airway obstruction.  Talking excitedly or laughing while eating, or eating too fast.
4. Recognize when a  Walking, playing, or running with objects in the mouth.
person has an airway  Swallowing problems caused by a stroke or other brain
obstruction.
5. Perform chest thrusts
disorders
for a conscious victim  Enlarging tonsils or tumors of the neck and throat
with an airway  Problems with the esophagus
obstruction.
6. Perform chest thrusts
for an unconscious
Signs and Symptoms
Being able to recognize when someone is choking is key to saving the victim.
victim with an airway
There are two types of obstructions that you need to know about partial airway
obstruction.
obstruction and complete airway obstruction. It is also important to be able to
recognize the differences between them and which first aid procedure to do.
1. Partial Airway Obstruction:

a. With good Air Exchange. (Air exchange is the movement of
air in and out of the lungs). When a person has a partial airway
obstruction with good air exchange, he or she can cough
forcefully. He or she may also wheeze between breaths. If the
person is able to cough forcefully on his or her own, do not
interfere with his or her attempts to cough up the object. You
should stay with the person and encourage him or her to continue
coughing. If coughing persists, call EMS for help.
b. With Poor Air Exchange. When a person has a partial airway
obstruction with poor air exchange, he or she will have weak,
ineffective cough and may make a high-pitched noise while
breathing. The obstruction may begin with poor air exchange, or it
Figure 10: Universal Distress
may begin with good air exchange and turn into an obstruction
Signal for Choking
with poor air exchange should be dealt with as if it were complete
airway obstruction.
33
. 2. Complete Airway Obstruction
When there is a complete obstruction of the airway, the person will not
be able to speak, breathe, or cough. The person may clutch at his or her throat
with one or both hands. This is the universal distress signal for choking (Fig.
10). You must act right away to clear the airway
First Aid
Conscious Victim
To find out if a conscious person is choking, ask, “Are you Choking?”
If he or she is choking. A conscious adult choking victim may not be able to
talk, cough, or breathe, and may do the universal choking sign with hands
around their throat. Separate the patient's feet, place one foot behind their feet,
and raise their elbows. Place one hand with thumb tucked in against the
abdomen, above the bellybutton, and grabs your fist with the other hand.
Perform abdominal thrusts until the object comes out of the patient's airway or
the patient becomes unconscious.
Refer to the skill sheets for Choking (Airway Obstruction)__conscious

Victim for the step-by-step procedure.
Unconscious Victim
To find out if the unconscious victim has an airway obstruction, to begin with
a primary survey to check the CAB as you did for rescue breathing.
1. Check for unresponsiveness.
2. If no response, shout, “Help!”
3. Position the victim; lower person safely to the ground.
4. Have someone phone EMS for help
5. Give 30 Compressions
6. Check for object
7. Give a breath.
8. Reposition, Reattempt
9. Give 30 compressions
10. Check for object, if object is seen, do finger sweep to remove it.
Repeat the last four steps (7-10) until air goes in and makes chest rise.
After breaths go in, check pulse, and continue CPR if the person shows no
signs of life. If there is breathing and pulse, monitor Airway, Breathing, and
Circulation until EMS arrives.
Refer to the skill sheets for Choking (Airway Obstruction)
__Unconscious Victim for the step-by-step procedure.
When to stop:
1. If the patient shows signs of life
2. Trained personnel or EMS take over
3. The scene become unsafe
4. The rescuer is too exhausted to continue.
34
Skill Sheets: Choking
If the victim is conscious
When practicing abdominal thrusts on a partner, do not give actual abdominal
thrusts.
Determine if Victim is Choking

Ask, “Are you choking?”
If victim cannot cough, speak, or breathe, shout,

“Help!”
say, “I can help.”
Phone EMS for Help

Tell someone to call for an ambulance.
Say, “Airway is obstructed, call_____________”

Perform Abdominal Thrusts

Stand behind victim.
Wrap arms around victim’s waist.
Make a fist with one hand place thumb side of fist (tucked in fist)
against middle of victim’s abdomen just above navel and well
below tip of breastbone.
Grasp your fist with your other hand.
Keeping elbows out, press fist into victim’s abdomen with a quick
inward and upward thrusts.
Each thrust should be a separate and distinct attempt to dislodge

the object, 1…2…3…4…5… [victim coughing]
Repeat thrusts until the airway obstruction is cleared or victim can

breathe or make sounds or victim becomes unconscious.
If a victim is choking loses consciousness while you are giving abdominal or

chest thrusts, you should for help and slowly lower the victim to the floor.
Make sure the victim’s head doesn’t hit the floor.
Kneel facing the victim and give 30 compressions

Provide CPR if needed, starting with 30 compressions at a rate of at
least 120 compressions per minute, followed by object check.
35
Check for Object
Open the Airway using a head tilt chin lift technique.
With victim’s face up, open the mouth and grasp both tongue
and lower jaw between thumb and fingers of hand nearer
victim’s legs; lift jaw.
Look in the mouth for any obstructions. If object is seen, do a

finger sweep to remove it.
Insert index finger into mouth along inside of cheek and deep
into throat to base of tongue.
Use “hooking” action to dislodge the object and move it into mouth
for removal.
Give a Breath
Maintain open airway with head-tilt/chin-lift.
Give a breath.
Even if no object is seen, attempt a breath. If air does not go in give

a second breath.
Reposition the Head, Reattempt a breath
If air does not go in, reposition the head and reattempt a breath. If
air still does not go in, continue compressions.
Repeat Sequence Until Airway Is Cleared
Give 2 breaths.
Reposition the head, Reattempt a breath
Give 30 compressions
Check for object
36
Continue CPR until
 The victim moves, speaks, blinks, or other wise reacts
 Someone with more advanced training arrives and takes over
Final Instructor check___________________
Common Question in Choking

1. Should I call EMS if the victim is conscious and the obstruction
comes out easily and quickly?
Answer
1. Yes. The object may cause tissues to swell and further complications
might arise later.
Choking with Special Situation

Chest Thrusts
In some situations you may not be able to get your arms around the waist of a
choking victim to deliver effective abdominal thrusts. For example, the
person may be greatly overweight or pregnant. In the case of a woman in the
late stages of pregnancy, abdominal thrusts could be dangerous. In both cases,
chest thrusts are performed instead of abdominal thrusts. Chest thrusts are
done in the following way:
Figure 11: Hand Placement for Chest Conscious Victim

Thrusts With the person either standing or sitting____
1. Stand behind the victim and place your arms under the armpits and
around the chest.
2. Place the thumb side of your fist on the middle of the breastbone
(Fig.11).
3. Grasp your fist with your other hand.
4. Give thrusts against the chest until the obstruction is cleared or until
the person loses consciousness (Fig.12).
Unconscious Victim
Chest thrusts should be given only to an unconscious person who is in the late
stages of pregnancy or who is greatly overweight. Follow the steps in the skill
sheets for giving first aid for choking to an unconscious victim.
Once a choking victim becomes unconscious, activate EMS. Perform
Figure 12: Giving Chest Thrusts
30 chest compressions, check for the object, and sweep out if possible.
Attempt two breaths.
If there is no chest rise and fall, attempt two more breaths. Continue
this process until the airway is open and air goes into the lungs. Then check
for a pulse for 10 seconds max. If present without breathing, continue rescue
breathing. If no pulse or breathing, begin CPR.
37
When a Conscious Victim Becomes Unconscious
If a victim who is choking loses consciousness while you are giving
abdominal or chest thrusts, you should shout for help and slowly lower the
victim to the floor while supporting the victim from behind. Make sure the
victim’s head doesn’t hit the floor.
Once you have lowered the victim to the floor, have someone phone EMS
for help, if it has already been done;
 Give a breath.
 Reposition, Reattempt
 Give 30 compressions
 Check for object
Figure 13: Self Abdominal Thrusts Repeat these four steps (give a breath. Reposition/reattempt, give 30
compressions, check for object) in the same sequence until the obstruction is
cleared or until EMS takes over.
If You Are Alone and Choking

If you are choking and no one is around to help, you can do an abdominal
thrust on yourself.
 Make a fist with one hand. Place the thumb side on the middle of
your abdomen slightly above the navel and well below the tip of
your breastbone.
 Grasp your fist with your other hand and give a quick upward thrust.
You can also lean forward and press your abdomen over any firm object
that does not have a sharp edge___ for example, the back of a chair (Fig.13)
38
Choking (Airway Obstruction) Action Guide
Survey the scene

Ask “ Are you choking?”
Can the victim respond by coughing forcefully,
Speaking or breathing?
_________________________________________________
Yes No
Identify yourself Shout “Help!”

If the victim is coughing forcefully, Say “ I can help you”
Encourage victim to continue coughing Phone EMS
And watch him or her until Begin abdominal thrusts
Obstruction is relieved Repeat untill object comes out or
Victim becomes unconscious
If coughing becomes weak or
Ineffective, get consent
Phone EMS
Begin abdominal thrusts
Repeat untill object comes out
or victim becomes unconscious
__________________________________________________
If victim becomes unconscious,

Position victim on back
Begin first aid for an unconscious victim

With airway obstruction
39
Unit 5: BLEEDING and shock
Definition
Learning Objectives
Bleeding is the loss of blood from the body. Bleeding may be external or
In this unit you will learn how to internal and can be divided into three types.
__Control bleeding in this order:
* Applying direct pressure Types of Bleeding
* Elevating the wound
* Pressing at pressure points Arterial bleeding is the loss of blood from an artery, which is a blood
* Applying a pressure bandage vessel that carries oxygen-rich blood from the heart through the body. The
* How to care for shock. blood spurts with each heartbeat, and the color is bright red. Arterial
bleeding is usually severe and hard to control, and it needs immediate
medical attention.
Venous bleeding is the loss of blood from a vein, which is a blood vessel
that carries blood without oxygen back to the heart. It has a steady flow,
which can be heavy, and the color is dark red, almost maroon. Venous
bleeding is easier to control than arterial bleeding.
Capillary bleeding is the loss of blood from capillaries, which are the
smallest blood vessels. The blood flow is usually slow. The threat of
infection is greater with capillary bleeding than it is with arterial or
venous bleeding.
Figure 13: Abrasion External Bleeding
External bleeding occurs with open wounds. Open wounds are injuries in
which the skin, one of the body’s soft tissue, is torn.
Types of open wounds include ____
 Abrasions ___ Damage to the skin from a scrape by a hard

surface, resulting in possible infection but little bleeding (Fig.
13).
 Incisions ___ Sharp, even cuts from knives, razor blades,

Figure 14: Incisions broken glass, and other sharp objects, possibly resulting in heavy
bleeding and damage to muscles, tendons, and nerves (Fig.14).
 Lacerations ___ Jagged or torn soft tissues usually caused

by objects having sharp, irregular edges or by force exerted
against the body; tissue damage is greater than in incisions
(Fig.15)
Figure 15: Laceration
40
 Punctures ___ Small holes in the tissues with little external
bleeding, caused by bullets and pointed objects such as pins,
nails, and splinters (Fig.16); possibility of internal bleeding and
infection, particularly tetanus infection.
Figure 16: Puncture
 Avulsions ___ Tissues torn or hanging from the body,

accompanied by heavy bleeding and resulting from accidents
involving motor vehicles or machinery, explosions, and animal
bites (Fig. 17); in many cases the tissue can be reattached to the
body by a surgeon.
Figure 17: Avulsion
 Amputations ___ Completes removal of body extremities,

such as fingers or legs, often with less bleeding than one might
expect. The removed part should be wrapped in a moist dressing
and placed in a plastic bag. The bag should then be placed in ice
water and transported with the victim, since it may be possible to
reattach it (Fig. 18).
Figure 18: Amputation
 Crushing injuries ___ Parts of the body caught between

heavy objects (such as industrial machinery) or thrown against
them (as in motor-vehicle accidents). Includes bone fractures as
well as injuries to internal organs (Fig. 19) and possible heavy
external and internal bleeding.
Figure 19: Crushing Injury
41
First Aid for External Bleeding
The purpose of first aid for external bleeding is to ___

 Stop the bleeding
 Prevent infection.
 Prevent shock.
As stated earlier, severe bleeding is arterial bleeding ___ bleeding

that spurts from a wound with every beat of the heart. It is life-threatening
and needs to be controlled immediately.
Keep in mind that a relatively small amount of bleeding can look
dramatic. Do not get so concerned at the sight of blood that you overlook
other injuries. Bleeding can also frighten the victim, so remember to
reassure him or her.
Infection can develop within hours or days of an injury. The signs
and symptoms of infection are pain or tenderness at the wound; redness,
heat, or swelling at the wound; pus beneath the skin or in the wound; red
streaks leading from the wound; and swollen lymph glands closest to the
wound (in the groin for a leg infection, in the armpit for an arm infection,
and in the neck for a head or neck infection). An infection can also cause
a person to feel ill. If any of these signs or symptoms develop, the victim
should get medical help.
To reduce your threat of infection, wear latex gloves or wash your
hands if possible before caring for a wound. Use clean dressings and
bandages, wash minor wounds that are not bleeding severely with soap
and water before applying the dressing. Do not try to clean major wounds
that are bleeding severely, since that might cause more bleeding.
To control bleeding ___

1. Apply direct pressure on the wound with a dressing. (Use your hand
alone if no dressing is available). A dressing is a clean covering
placed over the wound that protects it and helps control the bleeding
by absorbing the blood and allowing it to clot. Once you put a
dressing on a wound, do not remove it. If bleeding continues, add
new dressings on top of the one already soaked with blood. The less
a bleeding wound is disturbed, the better your chances of stopping
the bleeding.
2. If bleeding continues and you do not suspect a fracture, elevate the
wound above the level of the heart and continue to apply direct
pressure.
3. If the bleeding does not stop, the next step is to apply pressure at a
pressure point (Fig. 20). Continue to do steps 1 and 2.
4. The final step to control bleeding is to apply a pressure bandage. A
bandage is used to hold a dressing in place, restrain movement, and
help stop bleeding. Apply pressure while wrapping the bandage over
the dressing to keep pressure on the wound and slow the bleeding.
Take the pulse and examine the fingertips in the injured limb after
wrapping the bandage to make sure the bandage is not so tight that is
slows or stops circulation. If it is too tight, the pulse rate may be
slowed or absent and the fingertips or toes may look bluish.
Figure 20
Location of Pressure Points
You will practice the steps of bleeding control in the skill sheets that
follow.
42
Internal Bleeding
Internal bleeding ranges from small bruises to conditions serious enough
to cause shock, heart failure, or lung failure. It can result from crushing
injuries, punctures, injuries from blunt objects, tears in organs and blood
vessels, bruised tissues, and fractured bones.
If the victim is not properly checked, internal bleeding may go
unnoticed. A secondary survey helps to identify internal bleeding.
Signs and Symptoms

Signs and symptoms of internal bleeding are ___
 Bruised, swollen, tender, or rigid abdomen.
 Bruises on chest or signs of fractured ribs.
 Blood in vomit.
 Wounds that have penetrated the chest or abdomen.
 Bleeding from the rectum or vagina.
 Fractures of the pelvis.
 Abnormal pulse and difficult breathing
 Cool, moist skin.
First Aid
1. If the injury appears to be a simple bruise, apply cold packs (do
not put ice directly on the skin) to the area to prevent tissues
from swelling and to slow internal bleeding.
2. If you suspect more severe internal injury, get medical help
immediately. While waiting for help ___
o Monitor CAB.
o Reassure the victim and keep him or her still.
o Control all external bleeding.
o Care for shock (see the following section on shock).
o Loosen any tight-fitting clothing.
o If the victim is vomiting, place victim lying down on
his or her side so that any fluid can drain from the
mouth easily.
43
Bleeding and Shock Skill Sheets
Skill Sheets: How to Control External Bleeding
Forearm Wound
Apply Direct Pressure

Press firmly against wound with a sterile dressing, a clean cloth, or
your hand.
Elevation
Raise wound above level of heart. Do not elevate wound if you suspect a
fracture, or if elevating it hurts victim.
Pressure Points
While maintaining direct pressure and elevation on wound, locate
pressure point at brachial artery.
Apply pressure to brachial artery by squeezing the artery against the

underlying bone.
44
Pressure Bandage
Apply additional dressings over dressing already on wound.
Start by securing a self-adhering roller bandage over dressings
Continue wrapping the bandage around the limb. Use over-lapping turns
to cover dressings completely and secure them in place.
Tie off the bandage.
Check to be sure bandage is not too tight. (Radial Pulse should not be
slowed or absent; fingers should not look bluish).
Final Instructor Check ___________________________
45
External Bleeding Action Guide
Survey the scene
Do a primary survey
_____________________________
Yes No
Phone EMS Phone EMS if necessary
Control Bleeding Do a secondary survey
Apply direct pressure Control any minor bleeding
Does bleeding continue?
____________________________________
Yes No
Elevate (if fracture not suspected) Apply pressure bandage
And continue direct pressure Care for shock
Does bleeding continue?
______________________________________
Yes No
Press at pressure point, and Apply pressure bandage
Continue direct pressure and Care for shock
elevation
Has bleeding been controlled?
___________________________
Yes No
Apply pressure Continue direct pressure,
bandage elevation, and pressure at pressure point
Care for shock until EMS arrives
Care for shock
______________________________________________________________________________________________
To reduce the risk of being infected when you attempt to control bleeding, use some Sort of barrier, such as several
dressings, latex gloves, or a piece of plastic wrap. Always wash your hands as soon as you can after giving first aid.
After touching one victim, always change the gloves or wash your hands before touching another to avoid cross-
contamination.
46
Internal Bleeding Action Guide
Survey the scene

Do a primary survey
Phone EMS
Do a secondary survey
Are signs and symptoms of internal bleeding pressure?
______________________________________________________
Yes No
Monitor CAB Continue secondary survey
Reassure the victim
Control any external bleeding
Care for shock
If victim vomits,
Place him or her on side
______________________________________________________________________________
Signs and symptoms of internal bleeding can include any or all of the following; bruised, swollen, tender, or rigid
abdomen; bruises on chest or signs of fractured ribs; blood in vomit; wounds that have penetrated the chest or
abdomen; bleeding from the rectum or vagina; fractures of the pelvis; abnormal pulse and difficult breathing; and
cool, moist skin.
47
SHOCK
The first hour after a severe injury is the most important. The major problem
is the onset of shock. Once shock reaches a certain dangerous level, the victim
cannot be saved.
Definition
Shock is the failure of the cardiovascular system to keep adequate blood
circulation to the vital organs of the body (such as the brain, heart, and
lungs).
Shock develops as a result of the body’s attempts to correct damage
from severe injury.
Common Causes
Shock can be caused by bleeding, poisoning, insect bites and stings,
snakebites, electrical shock, burns, severe injuries, psychological trauma,
heart attack, and other medical conditions.
Signs and Symptoms

Shock has many signs and symptoms. These include confused behavior; very
fast or very slow pulse rate; very fast or very slow breathing; trembling and
weakness in arms and legs; cool and moist skin; pale or bluish skin, lips, and
fingernails; and enlarged pupils.
First Aid
Putting a victim in a lying-down position improves circulation. The exact
position depends on the victim’s injuries.
In caring for shock, follow the procedures appropriate to the situation:
 If you do not suspect head or neck injuries or leg fractures, place the
victim on his or her back, and elevate the feet and legs 8 to 12
inches, using available objects like blankets, pieces of wood, boxes,
and books (Fig. 21).
Figure 21: Usual Shock Position, raise legs over level of heart
If you suspect the victim has a head or neck injury, keep him or her lying flat
and wait for EMS. Do not move the victim unless there is immediate danger
from extreme hazards such as fire, toxic fumes, heavy traffic, electrical wires,
or deep or swiftly moving water. If you must move him or her, try not to bend
or twist the body. If you have any doubts about the victim’s injuries, keep him
or her lying flat (Fig. 22).
48

Figure 22
Shock Position: Suspected Head or Neck Injury
 If the victim vomits, place him or her on one side to avoid blocking
the airway with any fluids (Fig. 23). This position lets the fluids
drain from the mouth.
Figure 23
Shock Position: Victim Vomiting
 If the victim has trouble breathing, place him or her in a semi

reclining position, with boxes, pillows, or blankets raising the head
and back (Fig. 24). This makes breathing easier.
Figure 24
Shock Position: Difficult Breathing
In caring for shock, maintain the victim’s body temperature. Keep the
victim warm enough to keep him or her from chilling. Getting cold would
reduce the flow of blood. To warm the victim, put blankets underneath as well
as around the body, but do not overheat. Too much heat will draw blood away
from vital organs. If the victim is outside on a hot day, provide shade from
the sun and loosen clothing.
49
Shock Action Guides
Survey the scene
Do a primary survey
Phone EMS
Begin a secondary survey
Check Vital Signs
Are signs and symptoms of shock present?
______________________________________________
Yes No
Care for shock: Complete the secondary survey
* Position victim according to injury Reassure victim
* Maintain normal body temperature until EMS arrives
Monitor CAB Continue to monitor CAB
Are breathing and pulse skill present? Check for signs and symptoms of shock
_______________
Yes No
Monitor CAB Begin rescue breathing
or CPR, as appropriate
50
Unit 6: Poisoning
Learning Objectives Approximately 1 million poisonings are reported in the United States each
year. The majority of these poisoning victims are infants and children under
In this unit you will learn how to the age of 6 years. Providing emergency care for victims of poisoning
care for a victim who has; presents several problems to the lay public as well as EMS personnel. Some
1. Swallowed poison poisons are quick-acting, with characteristic signs and symptoms. Others are
2. Inhaled poison slow-acting and may not have immediate signs and symptoms. Sometimes
3. Absorbed poison you may be able to identify the poison, while at other times, it may be
4. Injected poison impossible.
To solve these problems, a network of Poison Control Centers (PCCs) has
been established. Most of the local PCCs can be reached 24 hours a day (Fig.
25). These centers are staffed by medical professionals who provide accurate
information on how to care for victims of poisoning. You should be as
familiar with the PCC number as you are with your local EMS number.
Definition
A poison is any substance – solid, liquid, or gas – that causes injury or death
when introduced into the body. There are four main ways a person can be
poisoned: by swallowing, by inhaling, by absorbing through the skin, and by
injecting (Fig. 26).
Poisons That Are ___
Figure 25
Phone Poison Control Center
A. Inhaled B. Swallowed
C. Absorbed D. Injected
Figure 26: Poisons
SWALLOWED POISON
Common Causes
The most common circumstances in which people swallow poison are taking
overdoses of medicine, taking drugs with alcohol, putting cleaning products
and other chemicals in unlabeled food containers, and being careless. Young.
51
children are a risk poisoning when medicines, plants, and household products
are within their reach
Signs and Symptoms
A person who has swallowed poison may show any or all of the following
signs and symptoms: evidence of an opened container or parts of plants
nearby; nausea, vomiting, and diarrhea; abnormal breathing and slow pulse;
unusual breath or body odors; burns around the mouth; drowsiness or
unconsciousness; and convulsions.
If you think that a poisoning may have occurred, do not wait for symptoms
to develop before calling the Poison Control Center and EMS.
First Aid
For first aid, quickly take any containers to the phone; then call EMS and the
local Poison Control Center and follow their instructions. Care for shock and
check breathing frequently. Do not give anything by mouth until you have
been advised by medical professionals.
Be sure to save any containers and vomit for EMS. These will help them
identify the poison and give the appropriate treatment.
INHALED POISON
Common Causes
Source of inhaled poisoning can include carbon monoxide (from car exhaust,
defective cooking equipment, fire, and charcoal grills), carbon dioxide (from
wells and sewers), smoke, refrigeration gases, fumes from spray chemicals,
and industrial and home chemicals.
Signs and Symptoms
The signs and symptoms of inhaled poisoning can include any or all of the
following: dizziness, weakness, headache, difficult breathing,
unconsciousness, and discoloration of the lips and mucous membranes.
First Aid
You must not put yourself in danger. Unless you are trained to enter a scene in
which poisonous gases are present and have the proper equipment, you should
not try to rescue a victim. Call EMS, and stay clear of danger.
If you can reach the victim, remove him or her from the poisonous
environment. Get to fresh air. Check CAB, Call EMS and the Poison Control
Center and follow their instructions. Monitor CAB.
If you work around poisonous chemicals, you should know first aid
procedures specific to them. Also, be familiar with available emergency
equipment such as masks; know where the equipment is kept and how to use
it. Be sure that your work area is properly ventilated.
52
ABSORBED POISON
Common Causes
Many absorbed poisons are corrosives or irritants that injure the skin and are
then taken into body tissues. People can be poisoned by insecticides;
agricultural, lawn, and garden chemicals: plants such as poison ivy, oak, or
sumac; and venom from certain marine life.
Signs and Symptoms
The signs and symptoms of absorbed poisoning include any or all of the
following: skin reactions, itching’ eye irritation, abnormal breathing and
pulse, and headache.
First Aid
Care for a victim of absorbed poisoning includes removing the victim from
the source of the poison, flushing all affected areas with lots of water,
removing clothes with the poison on them and caring for shock. Monitor
CAB.
INJECTED POISON
Sources of injected poisons are stings from insects and venomous marine life,
spider bites, snakebites, and drugs injected by needles. About 5 percent of
people stung or bitten will have an allergic reaction to the venom.
Care for injected poisons (other than injected drugs) is found in the unit on
bites and stings.
Swallowed Poison Action Guide

Survey the scene
Do a primary survey
Do you suspect the victim swallowed poison?
________________________________________
Yes No
Place victim on side if vomiting Do a secondary survey
Phone EMS and the Poison Control Center;
Have containers in hand if possible
Follow directions from EMS and
The Poison Control Center
Monitor CAB
Save containers and any vomit
To give EMS
53
Inhaled Poison Action Guide
Survey the scene
Is it safe for you to check victim?
__________________________________
Yes No
Shout, “Help!” Phone EMS
Remove victim from source of poison Stay clear of danger
Get victim to fresh air
Do a primary survey
Place victim on side if vomiting
Phone EMS and Poison Control Center
Follow their instructions
Monitor CAB
Absorbed Poison Action Guide

Survey the scene
Do a primary survey
Did victim come in contact with poison?
______________________________________
Yes No
Remove victim from source Do a secondary survey
of the poison
Wash or brush poison from skin
Remove clothing and other
Articles with poison on them
Phone EMS and the Poison

Control Center
Follow their instructions
Monitor CAB
______________________________________________________________________________
Be Prepared for Poisoning Emergencies
1. Keep the number of the Poison Control Center near each phone. Fill out the list of emergency phone
numbers at the end of this workbook, and put a copy by each phone. The Poison Control Center number for
your community is _________________________
2. Keep syrup of ipecac and activated charcoal on hand. Use these only when the Poison Control Center or
other medical professionals instruct you to do so.
54
Unit 7: Burns
Burns are injuries resulting from exposure to heat, chemicals, electricity, or
In this unit you will learn how to radiation. The severity of burns depends on their depth, size, and location.
care for ____ Burns are most serious when they are located on the face, neck, hands, feet,
1. Heat burns. and genitals; when they are spread over large areas of the body; or when they
2. Electrical burns are combined with other injuries, such as fractures. Burns bring the
3. Chemical burns possibilities of shock, pain, and infection. They are also more serious for the
very young and very old.
Common Causes
Burns have many causes, including carelessness with matches and cigarettes;
scalds from hot water and other liquids; defective heating, cooking, and
electrical equipment; unsafe use of flammable liquids to start fires and clean
floors; unsafe use of strong alkalis such as lye, or strong acids; and fires. The
hazards of fire include not only the visible burns but also respiratory and
circulatory emergencies.
Degrees of Burns
Burns are classified according to their depth, or degree. The deeper the burn,
the more severe it is. First-degree burns are the least severe. They are
characterized by redness or discoloration, mild swelling, and pain (Fig. 27).
They are usually the result of overexposure to the sun, light contact with hot
objects, minor scalding by hot water or steam, or brief contact with chemicals.
Second-degree burns are deeper than first-degree burns. They look red
or mottled and have blisters (Fig. 35). They may also look a little wet from
the loss of fluid through the damaged skin layers. They are usually the result
of very deep sunburn, contact with hot liquids, or flash burns when products
such as gasoline or kerosene burst into flame. Second-degree burns are often
the most painful because most of the nerve endings are still intact, even
though the tissue damage is severe.
Third-degree burns are the deepest burns. Burns of this type may look
white or charred, or they may look like second-degree burns (Fig.35). They
extend through all skin layer, and Sometimes into the structures below the
skin. Because they are so deep, only the edges will heal; scars will eventually
cover the rest of the burned area. Third-degree burns are most frequently
caused by ignited clothing, immersion in hot water, or contact with flames,
hot objects, or electricity. With third-degree burns, the victim may complain
of severe pain. If most nerve endings are destroyed, however, he or she may
feel very little pain.
Burns can appear in combination, with third-degree patches in the
middle of less serious burns. Judging the degree of a burn is sometimes aided
by knowing how long the victim was exposed to the source of the burn and
how hot the source was. Normally, the area of the body that was in contact
with the heat source for the longest time has the most severe burn.
First Aid for Heat Burns

Call EMS and then care for the burns. The major cause of shock in burn
victim is heavy loss of body fluids through the burned area. Have the victim
lie down. Elevate the burned part if doing so does not cause further pain. As
always for shock, maintain normal body temperature.
55
Figure 27: Degrees of Burns
In general, care for heat burns as follow:

 For first-degree burns and second-degree burns with no open blisters,
flush with lots of cool running water. Apply moist dressings, and
bandage loosely.
 For second-degree burns with open blisters and third-degree burns,
apply dry dressing and bandage loosely. Do not use water, as it
increases the risk of shock.
First Aid for Chemical Burns

Call EMS. Use lots of running water to flush chemicals from the skin (Fig.
28). As the action guide shows, keep flushing with water for 15 to 30 minutes,
and remove any clothing and jewelry on which chemicals have spilled. Cover
burns with dry, loose dressings. Care for possible shock, and do a primary
survey frequently.
First Aid for Electrical Burns

Be careful in electrical emergencies not to get an electrical shock yourself. If
the emergency is outside and you suspect downed power lines, call the power
Figure 28 company first. Do not touch downed power lines. If the emergency is inside,
Flushing a Chemical Burn turn off the electricity at the fuse box or circuit breaker. This means you and
others should know where the fuse box or circuit breakers are. Keep
bystanders well away from any source of live current.
While doing a primary survey, be aware that electrical burns carry a
strong possibility of cardiac arrest. Call EMS. As you do the secondary
survey, check for more than one burn site. Cover all burns with dry, loose
dressings and then bandage. Care for shock.
Radiation Burns
Radiation burns are not covered here, since it is extremely rare that you as a
person trained in basic first aid would be involved in radiation emergencies. If
you believe there has been exposure to radiation, contact EMS or civil defense
Figure 29 authorities in your community (Fig. 29).
Radiation Emblem
56
Heat Burns Action Guides
Survey the scene
Do a primary survey
Phone EMS if necessary
Are heat burns present?
______________________________________
Yes No
Degree of burn? Continue secondary survey
___________________________
1st degree or 2nd degree, 2nd degree with open

with closed blisters: blisters, or 3rd degree:
Flush with cool water Apply loose, dry, sterile

until pain subsides dressing, and bandage
Apply loose, moist, sterile Care for shock

dressing, and bandage
Care for shock
If you suspect the victim has inhaled smoke or chemicals (victim is hoarse and wheezing, breath smells like smoke),
remove victim from source of injury if it is safe for you to do so, monitor CAB, and phone EMS.
57
Chemical Burns Action Guides
Survey the scene
Do a primary survey
Phone EMS
Are chemical burns present?
___________________________________________________
Yes No
Flush immediately with large Continue secondary survey
Amounts of water for 15 to 30 minutes
Remove any affected clothing or jewelry
Cover with loose, dry, sterile
Dressing, and bandage
Care for shock
Electrical Burns Action Guides

Survey the scene
Are there downed electrical wires or cords?
________________________________________
Yes No
Check to make sure
Power source disconnected
Do a primary survey
Phone EMS
Check for multiple burn sites
Cover with loose, dry, sterile dressing,
and bandage
Care for shock
______________________________________________________________________________
In electrical emergencies, check for the source of electrical current. If inside, turn off the current at the fuse box or
circuit breaker. If outside, call the power company. Never touch downed power lines. Keep bystanders well away
from live current.
58
Unit 8: Temperature Extremes
Learning Objectives HEAT EMERGENCIES
In this unit you will learn how to On hot, humid days with no breeze, anyone may be affected by the heat.
care for a victim of; People who are especially susceptible to extreme heat are the very young and
1. Heat emergencies: the very old, the chronically ill, the overweight, those who work in hot place,
* Heat stroke and athletes. They may suffer heat stroke, heat exhaustion (Fig. 30), or heat
* Heat exhaustion. cramps.
* Heat cramps
2. Cold emergencies
* Hypothermia
* Frostbite.
Figure 30
Heat Exhaustion (left); Heat Stroke (right)
Heat Stroke
Heat stroke is life-threatening. The victim’s temperature-control system,
which produces sweating to cool the body, stops working. The body
temperature can rise so high that brain damage and death may result if the
body is not cooled quickly. Help must be fast. Quickly cool the victim’s body,
as shown in the action guide. Heat stroke requires medical attention.
Signs and Symptoms

Signs and symptoms of heat stroke are hot, red skin; very small pupils; and
very high body temperature – sometimes as high as 105 degrees F. If the
victim was sweating from heavy work or exercise, his or her skin may be wet;
otherwise, it will feel dry (Fig. 31).
First Aid
Heat stroke is a life-threatening situation. Call EMS. Get the person out of the
heat and into a cooler place. Cool the victim fast. Immerse him or her in a
cool bath, or wrap wet sheets around the body and fan it (Fig.32). Care for
shock while waiting for EMS to arrive. Give nothing by mouth.
59
Figure 31: Signs and Symptoms of Heat Stroke
Figure 32: First Aid for Heat Stroke
Heat Exhaustion
Heat exhaustion is less dangerous than heat stroke. It typically occurs when
people exercise heavily or work in a warm, humid place where body fluids are
lost through heavy sweating. Fluid loss causes blood flow to decrease in the
vital organs, resulting in a form of shock. With heat exhaustion, sweat does
not evaporate as it should, possibly because of high humidity or too many
layers of clothing. As a result, the body is not cooled effectively.
Signs and Symptoms

The usual signs and symptoms of heat exhaustion are cool, pale, and moist
skin; heavy sweating; dilated pupils; headache; nausea; dizziness; and
vomiting. Body temperature will be nearly normal.
First Aid
Get the person out of the heat and into a cooler place. Place him or her in the
shock position, lying on the back, with feet up. Either remove or loosen the
victim’s clothing. Cool him or her by fanning and applying cold packs
(putting a cloth between the pack and the victim’s skin) or wet towels or
sheets. Care for shock. Give the victim one-half glassful of water to drink
every 15 minutes, if he or she is fully conscious and can tolerate it. These
steps should bring improvement within a half hour.
60
Heat Cramps
Heat cramps are muscular pains and spasm due to heavy exertion. They
usually involve the abdominal muscles or legs. It is generally through that the
loss of water and salt from heavy sweating causes the cramps.
First Aid
As with other heat emergencies, get the person to a cooler place. If the victim
has no other injuries and can tolerate water, give him or her one-half glassful
every 15 minutes for an hour (Fig. 33).
COLD EMERGENCIES
On days with low temperatures, high winds, and humidity, anyone can suffer
from the extreme cold. Severe cold exposure can be life-threatening. Several
factors increase the harmful effects of cold: being very young or very old, wet
clothing, having wounds or fractures, smoking, drinking alcoholic beverages,
fatigue, emotional stress, and certain diseases and medications. People
exposed to severe cold can suffer from hypothermia or frostbite.
Hypothermia
Signs and Symptoms

Figure 33
First Aid for Heat Cramps The signs and symptoms of hypothermia include shivering, dizziness,
numbness, confusion, weakness, impaired judgment, impaired vision, and
drowsiness (Fig. 34). The stages are ___
1. Shivering
2. Apathy
3. Loss of consciousness
4. Decreasing pulse rate and breathing rate
5. Death
As hypothermia progresses, the victim may move clumsily and have

trouble holding things. In the later stages, he or she may stop shivering.
First Aid
Figure 34
Hypothermia As the action guide shows, call EMS. You should get a victim of hypothermia
out of the cold and into dry clothing. Warm up his or her body slowly. Give
nothing to eat or drink unless the victim is fully conscious. Monitor CAB.
Frostbite
Frostbite is the most common injury caused by exposure to cold. It happens

when ice crystals form in body tissues, usually the nose, ears, chin, cheeks,
fingers, or toes. This restricts blood flow to the injured parts. The effect is
worse if the frostbitten parts are thawed and then refrozen.
Figure 35
Mild Frostbite
61
Signs and Symptoms
The first signs of frostbite may be that the skin is slightly flushed. The skin
color of the frostbitten area then changes to white or grayish yellow and
finally grayish blue, as the frostbite develops. Pain is sometimes felt early on
but later goes away. The frostbitten part feels very cold and numb. The victim
may not be aware of the injury.
Frostbite has degrees and is graded based on how deep the tissue damage.
Mild frostbite looks white or grayish, and the skin feels hard, even though the
underlying tissue feels soft (Fig. 35). In moderate frostbite, large blisters form
on the surface and in the tissues underneath (Fig. 36). The frostbitten area is
Figure 36: Moderate Frostbite hard, cold, and insensitive. If freezing is deeper than the skin, tissue damage is
severe (Fig. 37). Gangrene may result from the loss of blood supply to the
area.
First Aid
Get the victim into a warm place. Put the frozen parts in warm (100-105
degrees) but not hot water. Handle them gently, and do not rub or massage
them. If the toes or fingers are affected, put dry, sterile gauze between them
after warming them. Loosely bandage the injured parts. If the part has been
thawed and refrozen, then you should re-warm it at room temperature.
Figure 37: Severe Frostbite
Cold Emergencies Action Guide

Survey the scene
Do a primary survey
Was the victim exposed to cold?
___________________________________
Yes No
Type of exposure? Continue secondary survey
______________________________________________
Hypothermia Frostbite
Remove from cold and get to warm place Remove from cold and get to warm place
Remove wet clothes and cover with Rewarm frozen part by immersing in
dry clothing or blankets warm (not hot) water; do not rub or massage
Warm body slowly Put dry, sterile gauze between warmed
Give nothing by mouth unless victim toes or fingers
Monitor CAB Loosely bandage
____________________________________________________________________________
For hypothermia, warm the victim slowly. Rapid warming could cause serious heart problems or increase
circulation to body surface, causing additional cooling of vital organs.
Do not give beverages containing alcohol or caffeine. Give warm broth or water.
62
Heat Emergencies Action Guide
Survey the scene
Do a primary survey
Was the victim exposed to heat?
_____________________________
Yes No
Check vital signs Continue secondary survey
____________________________________
* Cool, wet, pale skin * Hot, dry or wet, red skin

* Body temperature normal or lower * Body temperature very high
* Pupils dilated * Pupils constricted
Suspect heat exhaustion Suspect heat stroke

Remove from heat to cooler place Remove from heat to cooler place
Have victim rest and elevate feet Cool victim fast: immerse in cool bath
Loosen or remove clothing or wrap wet sheets around him or her
Cool but do not chill victim: fan and and direct fan over body
Apply cold packs or wet towels Care for shock
Care for shock Give nothing by mouth
If victim is conscious, give one-half glassful
of water every 15 minutes, as tolerated
Heat Cramps
Move to cooler place
Have victim stop activity
If no other injuries, give victim one-half glass of
Water every 15 minutes for 1 hour as tolerated
____________________________________________________________________________
A victim of extreme heat may first experience heat cramps and then heat exhaustion. If not helped, he or she can
suffer heat stroke, a life-threatening condition.
63
Unit 9: Fractures, Dislocations, Sprains, and
Strains
Learning Objectives The four major types of injuries that occur to bones, tendons, ligaments, and
muscles are fractures, dislocations, sprains, and strains. Since these injuries
In this unit you will learn how to; are hard to tell apart, as a person trained in first aid, you should care for all of
1. Care for: these as fractures.
* Fractures
* Dislocations FRACTURES
* Sprains
* Strains Definition
2. Splint the following: Fractures are breaks or cracks in bones. They are defined as either closed or
* The forearm open (Fig. 38). Broken or cracked bones are called closed (simple) fractures
* The leg when there are no visible wounds. Open (compound) fractures are more
* The ankle serous because of the open wound and the high risk of infection.
Fractures can be accompanied by internal injuries. For example, victims
with fractured ribs can also have injuries to the lungs, kidneys, or liver.
Figure 38: Closed Fracture and Open Fracture
Common Causes
Fractures can be caused by motor-vehicle accidents, falls, sports injuries, or
bone diseases. Ribs can be fractured when drivers are thrown against the
steering wheel in motor-vehicle accidents
Signs and Symptoms

Signs and symptoms of fractures include the sound of bone “snapping” a
grating sensation of bones rubbing together, obvious deformities, pain,
tenderness, swelling, bruising, and an inability to move the injured part.
Victims with fractured ribs may feel pain as they breathe.
64
DISLOCATIONS
Definition
A dislocation is an injury to a joint and the ligaments surrounding it. The ends
of the bone are displaced, making movement difficult and very painful.
Common Causes
Dislocations can be caused by falls, sports injuries, and motor-vehicle
accidents.
Signs and Symptoms

Signs and symptoms of a dislocation are similar to those of a fracture. They
include swelling, deformity, pain in a joint, loss of movement, and tenderness.
SPRAINS
Definition
Sprains are stretched or torn tendons, ligaments, and blood vessels around
joints, often at the ankle.
Common Causes
Like dislocations, sprains can be caused by falls, sports injuries, and motor-
vehicle accidents.
Signs and Symptoms

Signs and symptoms of sprains include pain at the joint, tenderness when
touched, discoloration, and swelling.
STRAINS
Definition
Strains are stretched or torn muscles, frequently in the back. A person with a
serious back strain should have medical attention before resuming activity.
Common Causes
Strains are usually caused by lifting something improperly or lifting
something too heavy.
Signs and Symptoms

Signs and symptoms of strains include sharp pain, stiffness, and possible
Figure 39 swelling.
Leg Splint
First Aid for Fractures, Dislocations, Sprains,
and Strains
Sometimes it is difficult to tell whether an injury is a fracture,
dislocation, sprain, or strain. Since you cannot be sure which of these a victim
might have, always care for it as a fracture. If EMS is on the way, do not
move the victim. Control any bleeding first. Care for shock, and monitor
CAB. If you are going to transport the victim to a medical facility, follow this
general rule: “When in doubt, splint.”
65
Splinting is a process of immobilizing a suspected fracture. Materials that
can immobilize a fractured bone and the joints above and below it can be used
to splint. (Examples are rolled-up newspapers, magazines, and pieces of
wood). Commercial splints are also available.
The purposes of splinting are:

 To immobilize a possibly fractured part of the body.
 To lessen pain
 To prevent further damage to soft tissues.
 To reduce the risk of serious bleeding
 To reduce the possibility of loss of circulation in the injured part.
 To prevent closed fractures from becoming open fractures.
The basic principles of splinting are:

 Splint only if you can do it without causing more pain and
discomfort to the victim.
 Splint an injury in the position you find it.
 Apply the splint so that it immobilizes the fractured bone and the
joints above and below the fracture.
 Check circulation before and after splinting.
If there are no splinting supplies available, splint the broken part of the
body to another part. For example, broken arm can be splinted to the chest. A
fractured leg can be splinted to the other uninjured leg (Fig. 39).
If the injury is a closed fracture, dislocation, sprain, or strain, apply a cold
pack. Do not apply a cold pack to an open fracture because doing so wound
requires you to put pressure on the open fracture site and may cause
discomfort to the victim.
For all of these injuries, care for shock and monitor CAB.
Head, Neck, and Back Injuries

Injury of the head, neck, and back (spinal injury) is serious and difficult to
care for. Think about these injuries as possibilities when caring for a victim
who has suffered traumatic injury. Examples of situations in which traumatic
injury may occur are falls, motor-vehicle accidents, and diving or other
sports-related accidents.
If the victim has an obvious head injury, suspect the possibility of spinal
cord injury also. If the victim is unconscious and your survey of the scene
suggests traumatic injury to the head, care for him or her as if there is a spinal
injury.
If you do suspect a spinal injury, stabilize the victim’s head and neck as
you found them by placing your hands along both sides of the head. This
keeps the head in line with the spine and prevents movement.
If you must move the victim, do it carefully, using the clothes drag rescue
method.
Stay with the victim and continue to stabilize the head and neck until EMS
arrives. Monitor CAB.
66
Sheets: How to Splint
How to Splint a Closed Forearm Fracture
You are doing a secondary survey and suspect that the victim may have a
closed fracture of the forearm.
Splint
If possible, have the victim support fractured arm in front of
body.
Check radial pulse on fractured arm.
Place splint under fractured forearm. Have victim or bystander hold

splint in place if possible.
67
Place a soft object (for example, a roll of gauze) in palm of
victim’s hand to keep hand in its natural position.
Cravat method to secure a forearm splints:

Make a cravat out of a triangular bandage: Start at the point
and fold toward the wider end.
Thread 2 cravats under splint, 1 above and the other below

the fracture.
Tie ends of each cravat together on underside of splint,

leaving fractured area uncovered.
Splint should be snug but not so tight that it constricts blood
flow to wrist.
Check radial pulse and look at fingertips to be sure cravats

are not too tight. (Fingertips wound look bluish).
68
Sling
Open a triangular bandage and thread one end under injured
arm so that it goes across victim’s chest and over uninjured
shoulder.
Bring other end of bandage over fractured arm, across chest,

and over opposite shoulder. Point of sling should now rest
behind elbow. Victim’s hand should be raised about 4
inches above elbow and fingertips should be exposed.
Tie ends of triangular bandage at side of neck opposite

injury. Place a pad under the knot.
Tie or pin the point of sling at elbow if possible.
Binder
Place center of cravat over fractured arm. Tie ends together
on opposite side under uninjured arm. Place a pad under
knot.
69
How to Splint a Leg with a Closed Fracture
closed fracture of the leg.
Leg Splint
Thread 5 cravats under legs: 1 each at ankles, at lower legs,
below knees, above knees, and at thighs. Leave fracture
exposed. Do not cover with cravat.
Place padding (blanket or pillow) between legs.
Tie ends of each cravat together, with knots on uninjured leg.
Check to see cravats are snug but not too tight. You should
be able to fit 1 finger only under the cravats.
How to Splint an Ankle

closed fracture of the ankle.
Ankle splint
Leave footwear in place (sock or shoe).
Thread 2 cravats under ankle and lower leg.
Fold or wrap blanket or pillow gently around ankle.
Firmly tie blanket or pillow in place around ankle and lower

leg with 2 cravats.
Tie a third cravat around the foot.
Check to see cravats are snug but not too tight
Final Instructor Check _______________________
70
Fractures, Dislocations, Sprains, and Strains Action Guide
Survey the scene

Do a primary survey
Was injury caused by force?
_________________________________
Yes No
Is skin broken? Continue secondary survey
___________________________
Yes No
(Open fracture) (Closed fracture, dislocation,
Control Bleeding sprain, or strain)
but do not elevate Check circulation
Check circulation Splint injured area
Splint injured area Apply a cold pack
Recheck circulation Recheck circulation
Care for shock Care for shock
Monitor CAB Monitor CAB
____________________________________________________________________________
Sometimes enough force can cause head, neck, or back injury. Signs and symptoms of these injuries can include
any or all of these: pain and swelling, unequal pupil size, blood or clear fluid draining from the nose or ears,
bruising under the eyes or behind the ears, loss of feeling in hands or feet, and an inability to move hands or feet.
If you suspect a head, neck, or back injury, do not move the victim or stop the flow of blood or clear fluids
coming from the nose or ears.
71
Unit 10: Eye and Nose Injuries
Learning Objectives EYE INJURIES
In this unit you will learn how to Since sight is so precious and eyes are so delicate, eye injuries are very
____ serious. Some eye injuries may lead to blindness.
1. Care for a chemical burn
in an eye. Common Causes
2. Care for a cut or an Foreign objects, chemicals, and dirt blown or rubbed into the eye can scratch
object in an eye. the surface of the eye or penetrate it. For this reason, people should never rub
3. Control a nosebleed their eyes when they feel something in them.
Signs and Symptoms

The most obvious sign of an eye injury is a clearly visible foreign object.
Other signs and symptoms are redness, burning, pain, headache, and tears.
First Aid
Be extremely careful when touching the eyes. Wash your hands when possible
before caring for an eye injury. Be gentle. If you cannot get a floating object
off the surface of the eye or eyelid by the method outlined in the action guide,
either loosely wrap a bandage around both eyes or tape dressings over them
(Fig. 40). You need to wrap both eyes, since having one’s eyes bandaged is
Figure 40 frightening. Get medical help.
Care for Eye: Floating Object An object that has become embedded in or has penetrated the eyeball
should not be removed by anyone but a doctor. First aid care for such an
injury is to place an inverted paper cup over the injured eye (Fig. 41). This
prevents further damage by keeping the object in place without pressure. Then
wrap a bandage around both eyes.
If the victim is unconscious, close the eyelids to keep the eyeballs from
drying out.
For chemical burns, wash the eye with lots of running water, flushing
from the nose outward, for 15 to 30 minutes (Fig. 42). Then wrap a bandage
loosely around both eyes and reassure the victim. Monitor CAB.
Figure 41 NOSE INJURIES

Care for Eye: Embedded Object
Severe nosebleeds can be frightening to the victim. It is possible that enough
blood can be lost to cause shock.
Common Causes
Causes of nosebleeds include injuries to the head, neck, or back, high blood
pressure; heavy exercise; colds; and changes in altitude.
First Aid
If you suspect that the victim has a possible head, neck, or back injury, do not
try to control a nosebleed. Stopping the blood flow would increase pressure
Figure 42 on injured soft tissues. Instead, leave the victim as you found him or her, and
Care for Eye: Chemical Burns stabilize the head and neck. If the victim is conscious, tell him or her not to
move.
72
If you do not suspect a head, neck, or back injury, try to control the
bleeding. Have the victim sit down and lean forward, chin toward chest. Then
pinch the nose shut (Fig. 43).
Encourage the victim to rest quietly, since walking, talking, laughing,
and blowing the nose can disturb blood clots and make the bleeding start
again.
Figure 43: Controlling Nosebleed
Eye Injuries Action Guides

Survey the scene
Do a primary survey
Is eye injury present?
_______________________________
Yes No
Type of injury Continue secondary survey
_____________________________________________
Chemicals burning the eye Object or cut in eye?
Wash eye with water, flushing

From nose outward,
For15 to 30 minutes _______________________________
Wrap bandage loosely around Penetrating object or cut Floating object.

Both eyes Position victim on back Life upper eyelid.
Reassure victim If penetrating object, Have victim look down.
Monitor CAB place cup over injured eye Flush eye with water.
Wrap bandage loosely Is object out?
Around both eyes
Reassure victim ______________________
Yes No
Continue Have victim close

Secondary survey both eyes
Wrap bandage loosely

around both eyes.
Stay with victim and

reassure
73
Nose Injuries Action Guides
Survey the scene
Do a primary survey
Is nosebleed present?
______________________________
Yes No
Head or neck injury suspected? Continue secondary survey
________________________
Yes No
Leave victim as Have victim sit down
You find him or her
Lean victim forward
Keep head and with chin toward chest
Neck from moving Pinch nose
Do not stop blood flow
____________________________________________________________________________
Nose injuries can indicate a possible head, neck, or back injury. Signs and symptoms of such injuries can include
any or all of these: pain and swelling, unequal pupil size, blood or clear fluid draining from the nose or ears,
bruising under the eyes or behind the ears, loss of feeling in hands or feet, and an inability to move hands or feet. If
you suspect a head, neck, or back injury, do not move the victim or stop the flow of blood and clear fluids coming
from the nose or ears.
74
Unit 11: Diabetic Emergencies

To maintain life, blood carries sugar as nourishment for body cells. Insulin is
In this unit you will learn how to a hormone that helps the body to use the sugar. When enough insulin is not
care for a victim of ___ available, body cells do not get enough nourishment, and diabetes results.
1. Insulin reaction (insulin People with diabetes keep their condition under control by taking medication
shock). and regulating their diet and activity. In diabetes, two very different
2. Diabetic coma. emergencies can arise: insulin reaction (insulin shock) and diabetic coma.
Insulin reaction occurs when too much insulin is in the body. Too much
insulin rapidly reduces the level of sugar in the blood, and brain cells suffer.
Insulin reaction can be caused by taking too much medication, by failing to
eat, by heavy exercise, and by emotional factors.
Diabetic coma happens when there is too much sugar and too little
insulin in the blood, and body cells do not get enough nourishment. Diabetic
coma can be caused by eating too much sugar, by not taking prescribed
medication, by stress, and by infection.
Signs and Symptoms

The signs and symptoms of insulin reaction are fast breathing, fast pulse,
dizziness, weakness, change in the level of consciousness, vision difficulties,
sweating, headache, numb hands or feet, and hunger.
Diabetic coma develops more slowly than insulin reaction, sometimes
over day. Signs and symptoms include drowsiness and confusion, deep and
fast breathing, thirst, dehydration, fever, a change in the level of
consciousness, and peculiar sweet or fruity-smelling breathe.
Besides being aware of the different signs and symptoms listed above,
you can ask someone who is conscious these questions: “Have you eaten
today?” and “Have you taken your medication today?” Someone who has
eaten but has not taken his or her medication may be in diabetic coma.
Someone who has not eaten but has taken his or her medication may be
having an insulin reaction.
First Aid
In a diabetic emergency. It is possible to confuse the signs and symptoms of
insulin reaction and diabetic coma. Since insulin reaction is a true emergency
that needs quick response, give any fully conscious person in a diabetic
emergency sugar – candy, fruit, juice, or a soft drink containing sugar. This
will quickly get sugar into the blood to help someone having an insulin
reaction. If instead of having an insulin reaction, he or she is in diabetic coma,
the sugar will not cause further harm.
If the person is unconscious, check ABCs and call EMS. A victim of
diabetic coma also needs immediate transport to the hospital. Again, check
CAB and call EMS.
75
Diabetic Emergencies Action Guide
Survey the scene

Do a primary survey
Can you tell the difference between
Insulin reaction (insulin shock) and
Diabetic coma?
______________________________________
Yes No
Type of diabetic emergency? Is victim conscious?
_______________________ ________________
Insulin reaction Diabetic coma Yes No

Is victim conscious? Is victim conscious? Give Monitor CAB
Sugar: Care for shock
______________ ______________ candy,
Fruit juice
Yes No Yes No or soft drink
Give Monitor CAB Victim needs Monitor CAB
Sugar: Care for shock medication victim needs
Candy, medication
Fruit juice,
or soft drink
76
Unit 12: Bites and Stings
Learning Objectives HUMAN AND ANIMAL BITES
In this unit you will learn how to The mouths of people and animals are full of bacteria. A person who is bitten
care for ____ runs a high risk of infection (Fig. 44). In general, people who are bitten by
1. Human and animal bites. animals or other people should get medical help (Fig. 45). They should also
2. Insect bites and stings. check to see if their tetanus immunizations are current.
3. Allergic reactions to bites
and stings. Signs and Symptoms
4. Snakebites. Infection can develop within hours or days of the injury. The signs and
symptoms of infection are pain or tenderness at the wound; redness, heat, or
swelling at the wound; pus beneath the skin or in the wound; red streaks
leading from the wound; and swollen lymph glands closest to the wound (in
the groin for a leg infection, in the armpit for an arm infection, and in the neck
for a head or neck infection). An infection can also cause a person to feel ill.
If any of these signs or symptoms developed, the victim should get medical
help.
First Aid
Dangerous infection can develop even from a minor bite. To help prevent
infection, either wear latex gloves or wash your hands if possible before
caring for someone with open wounds. If there is not heavy bleeding, wash
wounds well with soap and water; then cover them with a clean dressing,
Figure 44: Human Bite
bandage them, and seek medical help. Do not try to clean a wound that is
bleeding heavily. Control the bleeding. Once it stops, cleaning might make it
start again. Leave the dressing in place. A serious wound should be cleaned
only by trained medical personnel.
Rabies
Rabies is an extremely serious illness transmitted to people through the saliva

of diseased animals such as skunks, bats, raccoons, cattle, cats, dogs, and
foxes. This can happen when a diseased animal bites people or licks open
wounds on them. Since there is no proven cure for rabies, a person who is
bitten by an animal that may be rabid must get medical help. If the animal is
rabid, a series of shots (vaccines) must be given to the victim in order to build
up body immunity in time to prevent the disease.
Animals with rabies act in unusual ways. For example, a wild animal
with rabies might not run away from people. A rabid animal sometimes
drools. Sometimes it acts irritable or strangely quiet. It might be partly
Figure 45: Animal Bite paralyzed.
If you think an animal that has bitten someone is rabid, notify EMS, the
police, and animal control. Tell the proper authorities what the animal looked
like and where it was. They will capture it and then watch for signs of rabies.
Never try to restrain the animal yourself. Keep away from it.
77
INSECT BITES AND STINGS
Insect bites and stings can be life-threatening to people who suffer severe
allergic reactions (Fig. 46).
Signs and Symptoms

To give first aid, you need to know the signs and symptoms of allergic
reaction. These may include pain, swelling of the throat, redness or
discoloration at the site, itching, hives, decreased consciousness, and difficult
or noisy breathing. In caring for any sting or bite, you should be on the alert
for signs of shock, which may occur from severe allergic reaction.
First Aid
If the victim was stung and the stinger remains embedded, try to remove it.
Do not squeeze the stinger, since that will release more venom into the blood.
Instead, use tweezers to remove the stinger, or scrape it away with something
like a credit card. Wash well with soap and water. Put a cold pack on the area
that has been stung to reduce swelling and pain. Place the stung area below
the level of the heart to slow circulation of the venom.
If you see signs and symptoms of allergic reaction, call EMS quickly.
While waiting for EMS to arrive, care for shock, and monitor CAB.
SNAKEBITES
Very few people die from snakebites (Fig. 47). However, anyone who is
bitten by a snake should get medical help quickly. If EMS is more than 30
minutes away, transport the victim to medical care in another vehicle if
possible.
Reassure the victim and keep him or her still until EMS arrives. Keeping
still will slow down absorption of the snake venom, as will keeping the bitten
area below the level of the heart. If the bite is on an arm or leg, splint. Be alert
to prevent shock.
Try to remember what the snake looked like, so you can tell EMS.
Figure 46
Insect Stings
Figure 47
Snake Bites
Figure 47: Snake Bite Marks
78
Human and Animal Bites Action Guides
Survey the scene
Do a primary survey
Human or animal bite?
__________________________
Yes No
Is skin broken? Continue secondary survey
_____________________________
Yes No
Is heavy bleeding present? Continue secondary survey
Check for fracture
___________________
Yes No
Control bleeding Wash wound
Care for shock Apply bandage
Reassure victim
___________________________________________________________________________________________
In the case of an animal bite, the animal needs to be captured for observation to check for rabies. Do not attempt
to do this yourself. The proper authorities, such as the police and animal control, will try to capture the animal to
observe it for rabies.
79
Insect Bites and Stings Action Guides
Survey the scene

Do a primary survey
Phone EMS if allergic reaction
Insect bite or stings?
__________________________________________
Yes No
If arm or leg affected, put bitten area Continue secondary survey
Below the level of the heart
Remove any embedded stinger

With tweezers or scrape off
With object like a credit card
Wash well with soap and water
Cover affected area with dressing

And apply cold pack
If allergic reaction, care for shock

Monitor CAB
Snakebites Action Guides

Survey the scene
Do a primary survey
Phone EMS
(or transport if EMS is more than 30 minutes away)
Snakebite?
_________________________________________
Yes No
Keep victim calm Continue secondary survey
If bite on arm or leg, keep bitten area below
The level of the heart and splint
Care for shock

Monitor CAB
___________________________________________________________________________________________
Signs and symptoms of allergic reaction include: pain, swelling of the throat, redness or discoloration at the site,
itching, hives, decreased consciousness, or difficult or noisy breath in.
80
Unit 13: Seizures
Learning Objectives Common Causes
In this unit you will learn how to Seizures are very common occurrences, but they are not completely
care for a victim of a seizure. understood. They may be caused by a temporary problem, such as insulin
shock, high fever, viral infections of the brain, head injury, or drug reactions.
When seizures recur, and there are no underlying causes that can be treated
directly, a person is said to have epilepsy. Epilepsy is usually well controlled
with medication, but some people who have it continue to have seizure from
time to time.
Signs and symptoms
Some individuals have an aura (sensation) before the onset of a seizure. Auras
can be sound and vision hallucinations, a strange taste in the mouth,
abdominal pain, numbness, or a sense of urgency to move to safety.
Seizures can range from mild to severe --- brief blackouts, involuntary
Figure 48 movements, sudden falls, periods of confused behavior, and convulsions
Preventing Injury by Clearing (involuntary muscle contractions). Severe seizures may involve uncontrollable
Area muscle movements (jerking or spasms) and rigidity, loss of consciousness,
loss of bladder and bowel control, and in some cases, breathing that stops
temporarily.
First Aid
If you know the person has epilepsy, it is usually not necessary to call EMS
unless ___
 The seizure lasts longer than a few minutes.
 Another seizure begins soon after the first.
 He or she does not regain consciousness after the jerking movements
have stopped.
However, you should call EMS when someone having a seizure also ___
 Is pregnant
 Carries identification as a diabetic
 Appears to be injured.
 Is in the water and has swallowed large amounts of water.
A person having a seizure cannot control it. As someone trained in first aid,
you can prevent injuries to him or her by removing anything nearby that
might get in the way, such as furniture or equipment (Fig. 48). You can also
prevent injuries by not interfering: Do not try to put anything between the
teeth. Also, do not hold or restrain the person. Loosen clothing. If the victim
vomits, roll him or her on one side.
Following a seizure, the muscles relax. Check CAB. A person
recovering from a seizure is likely to be drowsy and disoriented. He or she
needs rest and reassurance. Stay with the person until he or she is fully
conscious and aware of surrounding once again.
81
Seizure Action Guide
Survey the scene

Do a primary survey
Is the victim having a convulsive seizure?
_______________________________________
Yes No
Protect victim from injury, but Continue secondary survey
do not restrain
Do not place any object between

victim’s teeth
Loosen clothing
If victim vomits, roll him or
her on one side
When victim begins to relax,

check CAB
Reassure victim
82
Unit 14: Stroke
Learning Objective Definition

A stroke is a condition that occurs when the blood flow to the brain is
In this unit you will learn how to interrupted long enough to cause damage. People over age 50 are the most
care for a victim of a stroke common victims, but younger people can have them, too.
Common Causes
There are three causes of stroke:
1. The most common cause is a clot (thrombus or embolism) formed in
an artery in the brain or carried to the brain in the bloodstream (Fig.
49).
2. A second cause is a ruptured artery in the brain, resulting from a
head injury, high blood pressure, a weak spot in the wall of a blood
vessel (aneurysm), or fat deposits lining a vessel (atherosclerosis).
3. The third cause is compression of an artery in the brain, decreasing
the blood flow. This is often the result of a brain tumor.
Signs and Symptoms

The general signs and symptoms of stroke are weakness and numbness of the
face, arm, or leg, often on one side only. Other possibilities are dizziness,
confusion, headache, ringing in the ears, a change of mood, difficulty in
Figure 49 speaking, unconsciousness, pupils of unequal size, difficulty in breathing and
Blood Clot in Brain swallowing, and loss of bowel and bladder control.
First Aid
A person having a stroke needs to stop what he or she is doing and rest. Call
EMS. Reassure the victim, let him or her find the most comfortable position
for breathing. Don’t give anything by mouth. If the victim vomits, place him
or her on the affected side so that any fluids can drain from the mouth
(Fig.50). Monitor CAB.
Figure 50
Shock Position: Stroke Victim Vomiting
83
Stroke Action Guide
Survey the scene

Do a primary survey
Phone EMS
Do you suspect stroke?
_____________________________
Yes No
Is victim conscious? Continue secondary survey
_______________________________
Yes No
Let victim find most comfortable Monitor CAB
Position for breathing If victim vomits, place
Do not give anything him or her on affected side
By mouth
Monitor CAB
If victim vomits, place
Him or her on affected side
Reassure victim
84
Unit 15: First Aid and Infectious Disease
Learning Objectives You may be concerned about the possibility of contracting an infectious
disease when you provide basic first aid. The following information addresses
some of the most common health concerns in providing first aid.
In this unit you will learn how to You will probably use your first aid skills to help someone whom you
___ know personally --- a family member, a friend, a co-worker. For this reason it
1. Recognize infectious is possible you will know your risk of contracting an infectious disease. As a
diseases person trained in first aid, you should know that there are blood-borne
2. Prevent infectious diseases such as hepatitis and HIV (the AIDS virus) and air-borne diseases
while you give first aid such as influenza. Adopt practices that discourage the spread of disease when
3. Recognize kinds of performing first aid.
equipment Although it does not often happen, several blood-borne infectious diseases
can be transmitted through direct contact between the blood of an infected
person and sores or open cuts on your skin or in your mouth. To reduce the
risk of being infected when you attempt to control bleeding, use some sort of
barrier, such as several dressings, latex gloves, or a piece of plastic wrap,
between you and the victim’s blood if possible. Wearing latex gloves helps
you to avoid direct skin contact with other body fluids such as vomits, feces,
or urine. Always wash your hand as soon as you can after giving first aid.
Some air-borne infectious diseases and viruses can be transmitted by the
air when we breathe. A person trained in first aid exchanges air with a victim
during rescue breathing. You will probably know the person on whom you
will perform rescue breathing; therefore you may know the likelihood of
contracting an infectious disease or virus from that person’s breath.
Saliva exchange during mouth-to-mouth contact is another method of
possible infectious disease transmission. Rescue breathing and CPR generally
involve mouth-to-mouth contact. A person trained in first aid may risk
contracting some viruses and infectious diseases from saliva in order to save a
life. However, at the writing date of this manual, there is no evidence that you
can be infected by hepatitis B virus or HIV (AIDS virus) either through
contact with human saliva or by giving rescue breathing.
Infectious Disease Involve:

 Bronchitis
 Chicken Pox
 Croup
 Diphtheria
 Bird Flu (Avian Influenza)
 Gastro-Enteritis
 Gonorrhoea
 German Measles
 Hepatitis A
 Hepatitis B
 Hepatitis C
 HIV/AIDS
 Whooping Cough
 SARS (Severe Acute Respiratory Syndrome) = pnemonia
 MERS (Middle East Respiratory Syndrome) = lower airway
infection
 COVID – 19 (Corona)
85
Note;
A person with hepatitis B infection will test positive for the hepatitis B
surface antigen (HbsAg). Most persons infected with hepatitis B will get
better within a period of time. However, some hepatitis B infections will
become chronic and will linger for much longer. These persons will continue
to test positive for HBsAg, and their decision to participate in CPR should be
guide by their physician.
After a person has had an acute hepatitis B infection, he or she will no
longer test positive for the surface antigen but will test positive for the
hepatitis B antibody (anti-HBs). Persons who have been vaccinated for
hepatitis B will also test positive for the hepatitis antibody. A positive test for
the hepatitis B antibody (anti-HBs) should not be confused with a positive
test for the hepatitis B surface antigen (HbsAg).
86
Unit 16: Rescues
Learning Objectives When There Is No Immediate Danger
In this unit you will learn when it If there is no immediate danger present, you should follow the emergency
is appropriate to move a victim action principles and care for the victim at the scene while waiting for
using the following methods; EMS to arrive. Your task is to give basic life support and keep injuries
1. Two-handed seat carry from getting worse. Moving a victim can make some injuries worse. For
2. Clothes drag example, carelessly moving someone with a closed fracture could result in
3. Foot drag. an open fracture. This would cause bleeding, possible nerve and muscle
damage, and an increased chance of infection.
Remember: Unless it is absolutely necessary, do not move a victim. It is
the role of EMS to move victims from the scene of the injury.
When There Is Immediate Danger
You should rescue or move a victim only if there is immediate danger to

you and him or her. Immediate danger would be from fire, lack of oxygen,
serious traffic hazard, risk of drowning, risk of explosion, exposure to bad
weather, collapsing buildings, and electrical hazards. Being near a car that
has been involved in an accident is not in itself dangerous. Cars rarely
explode after accidents. However, you should always check to see that the
car is in no danger of moving. Put on the parking brake and turn off the
ignition if you can do these without moving the victim.
87
How to Move a Victim
If there is immediate danger and you must move a victim, remember to
_____
 Provide support for the victim’s neck and spine
 Avoid bending or twisting the victim
 Drag a victim to safety, keeping the body straight. Never move it
sideways.
 Lift from your knees, not with you back.
This unit gives three rescues to consider using when it becomes necessary
to move a victim:
 If there is a second person who can help and you do not suspect a
spinal injury, use the two-handed seat carry (Fig. 18).
 If you are alone and you suspect the victim might have a spinal
injury, use the clothes drag (Fig. 18). This allows you to give
support to the victim’s head while moving him or her.
Figure 52: Clothes Drag
 If the victim is very large, you can use the foot drag (Fig. 19) as
long as the victim’s head will not be injured by bumpy or rough
ground.
Figure 51: Two-Handed Seat

Carry Figure 53: Foot Drag
88
References
1. Stephen G. Lynn, Cardiopulmonary Resuscitation, American
Heart Association, New York, 2010
2. Travers, Berg. Et. Al. Circulation, 2010
3. WebMD Medical Reference from Healthwise, 2013
4. America Red Cross, ProTrainings platform. All content Copyright
© 2013,
5. America Red Cross, ProCPR platform. All content Copyright ©
2013,
6. Total Burn Care, 3rd Edition, Edited by David Herndon,
Saunders, 2007.
7. Sevitt S (May 1979). "A review of the complications of burns,
their origin and importance for illness and death". J
Trauma 19 (5): 358–69.doi:10.1097/00005373-197905000-
00010. PMID 448773.
8. Ron Walls MD; John J. Ratey MD; Robert I. Simon MD
(2009). Rosen's Emergency Medicine: Expert Consult Premium
Edition - Enhanced Online Features and Print (Rosen's
Emergency Medicine: Concepts & Clinical Practice (2v.)). St.
Louis: Mosby. ISBN 0-323-05472-2.
9. Injury Chicago Electrical Trauma Research Institute Accessed
April 27, 2010
10. Electrical Burns: First Aid Mayo Clinic Accessed February 24,
2008
11. Wright RK, Davis JH: The investigation of electrical deaths: A
report of 220 fatalities. J Forensic Sci 25:514, 1980
12. Hunter, Tim B; Leonard F Peltier, Pamela J Lund (May
2000). "Musculoskeletal Eponyms: Who Are Those
Guys?". RadioGraphics 20 (3): 819–836. Retrieved 2009-10-17.
13. Mellick LB, Milker L, Egsieker E (October 1999). "Childhood
accidental spiral tibial (CAST) fractures". Pediatr Emerg
Care 15 (5): 307–9. doi:10.1097/00006565-199910000-
00001.PMID 10532655.
14. Tim B Hunter, Leonard F Peltier, Pamela J Lund
(2000). "Musculoskeletal Eponyms: Who Are Those
Guys?". RadioGraphics 20: 829. Retrieved 2009-11-13.
15. Perry, CR; Rice S, Rao A, Burdge R. (Oct 1983). "Posterior
fracture-dislocation of the distal part of the fibula. Mechanism
and staging of injury.". J Bone Joint Surg Am. 65 (8): 1149–
57.PMID 6630259. Retrieved 2009-10-10
16. TheFreeDictionary > Lisfranc's fracture Citing: Mosby's Medical
Dictionary, 8th edition. Copyright 2009
17. http://www.ota.org/compendium/2007JOTFractureCompNew/970
42.2Introduction%20S1-S6.pdf
18. "Fracture and dislocation compendium. Orthopaedic Trauma
Association Committee for Coding and Classification" (pdf). J
Orthop Trauma 10 Suppl 1: v–ix, 1–154. 1996. PMID 8814583.
Archived from the original on 2007-09-28. Retrieved 2007-11-28.
19. Mosby’s Medical, Nursing and Allied Health Dictionary, Fourth
Edition, Mosby-Year Book Inc., 1994, p. 1395
20. Allan Braslow, Ph.D., Faculty, National Conference on CPR and
Emergency Cardiac Care; Braslow & Associates, 198
89

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A. Survey the Scene

1. Is the scene safe?

If a person is lying next to a ladder, you may suspect that he or she

3. How many People are injured?

4. Are there bystanders who can help?

5. Identify Yourself as a Person Trained in First Aid

Figure 1: Survey the Scene

C. Phone the Emergency Medical Services (EMS) for Help

A secondary survey has three steps:

Victim and Bystander Interviews

Survey the scene

Begin first aid for

O O Interview the victim

Get permission to give care

Ask the victim’s name.

Ask, “What happened?”

Ask, “Do you have any pain or discomfort?”

Ask, Do you have any allergies?”

Ask, “Are you taking any medications?”

O O Check Vital Signs

Determine Radial or Carotid Pulse Rate.

Tell victim you are going to take his or her pulse.

Carotid Pulse – Locate Adam’s apple with middle and index

Record pulse rate: ______________

Beats in 30 seconds x 2 = Beats per minute

Determine Breathing Rate.

Watch rise and fall of victim’s chest and abdomen.

Count number of breaths in 30 seconds. Multiply by 2. This is the number

Record breathing rate: ____________________

Breaths in 30 seconds x 2 = Breaths per minute

Determine Skin Appearance.

Feel victim’s forehead with back of your hand.

Look at victim’s face and lips.

Record skin appearance:

Check and compare pupils of both eyes.

Check for fluid or blood in ears, nose, and mouth.

Check victim’s abdomen for tenderness by pressing lightly with flat

Press firmly on the hips. Look for signs of injury.

Record Your Findings.

Final instructor Check ________________________________________

Common Cause of Breathing Emergencies

Breathing emergencies may be caused by:

Do not stop Rescue Breathing or EAR unless on of the following occurs:

 The victim begins to breathe unaided / shows signs of life.

Common Question in Rescue Breathing

2. No. When the heart stops beating, blood no longer circulates

Check for Unresponsiveness (Does victim respond?)

Ask, “Are you OK?”

If no response, shout for help

Position the Victim

Carefully place the person on their back

Straighten victim’s legs, if necessary, and move arm

Roll victim toward you as a single unit: as you roll victim,

Place victim’s arm nearer you alongside victim’s body.

Maintain head-tilt with one hand on victim’s forehead.

Locate Adam’s apple with middle and index fingers of other

Slide fingers down into groove of neck on side closer to you.

Feel for carotid pulse for no more than 10 seconds.

Say, “Has pulse.”

Open the Airway (Use head-tilt-chin lift method)

Support the jaw with your fingers in a "pistol grip position