Special Considerations:

1. Open Chest Wound

5. Bullet Wounds
6. Blast Injury

2. Open Abdominal Wound

BURNS

Source of Burns

1. Thermal/Heat
2. Electrical
3. Radiation
4. Chemical

Thermal Burns MGMT

3. Avulsion

Chemical Burns MGMT

4. Embedded Object
Electrical Burns
  Call the local emergency number if the person has
any trouble breathing or shows any other signals
of anaphylaxis.
 Marine life with poisonous spines
Radiation Burns
Marine life with poi. spines MGMT

 Immerse the wound in 45°C water, or as can be

tolerated, for 30 to 90 minutes. Many marine
toxins are proteins that are destroyed by heat.
 Soak the affected area in vinegar. This inhibits
POISONING bacterial infection and dissolves the spine skeleton
which is made of calcium carbonate--the same
Poisoning by Ingestion: basic material as human bones.
 Leave an inaccessible spine alone and only if it
 Food poisoning
hasn't penetrated a joint, nerve or blood vessel.
 Caustics- muriatic, carbatt fluids, solid and  Cleanse the wound with an antiseptic solution.
liquid drain, detergents, amonia  Washing out remaining venom and pieces of the
 Hydrocarbons spine will help minimize damage, speed healing
 Drug overdose and prevent infection.
Poisoning by Inhalation Absorbed poison MGMT
 Carbon Monoxide
 Remove contaminated clothing and jewelry
 Cyanide
which may constrict circulation when swelling
 Chlorine
occurs.
 Tear gas
 Rinse the affected area immediately. Do it
Poisoning by Injection thoroughly.
 Seek medical advice if a rash or weeping lesion
 Snakebites (oozing sore) develops.
 Soothe the area with medicated lotions.
Snakebites MGMT  Stop or reduce itching with antihistamines that
will dry up the lesions.
 Reassure the patient who may be very anxious.  Advice the victim to see a physician if the
 Avoid any interference with the bite wound such condition worsens and large areas of the body or
as incising, rubbing, vigorous cleaning, massaging the face are affected..
or applying herbs or chemicals to it.  Give care for severe allergic reactions if it does
 Immobilize the whole of the patient's body by develop.
laying him/her down in a comfortable and safe  Remove contaminated clothing and jewelry
position. which may constrict circulation when swelling
 Ideally, a broad elastic roller bandage should be occurs.
used for the person.
• Do not remove the trousers as the movement of
doing so will only assist the venom into entering
the blood stream.
 As far as the snake is concerned - do not attempt
to kill it as this may be dangerous.
 Bee stings

Beestings MGMT HEAD AND SPINE INJURY

Types:
 Remove any visible stinger. Scrape it away from
the skin with a clean fingernail or a plastic card.  Head injury
 Wash the site with soap and water.  Concussion
 Cover the site with a dressing.  Spinal injury
 Apply a cold pack to the area to reduce pain and
swelling.
Head injury
  Control any external bleeding with direct pressure
unless the bleeding is located directly over a
suspected fracture. Wear disposable gloves or use
another barrier.
 Help victim maintain normal body temperature.

MANUAL HEAD STABILIZATION

Helmet Removal

Removal of the helmet is necessary when there

is:

Concussion  Uncontrollable and excessive head movements.

 Restriction of airway or breathing.
 Inability to assess and/or reassess the patient's
airway and breathing.
 Proper spinal immobilization cannot be
performed because of the helmet.
 Patient needs to be resuscitated, such as when
having a cardiac arrest.

Spinal injury

BONES, JOINTS, AND MUSCLE INJURIES

Types:

 Strain

Spinal Cord Injury MGMT

 Call the local emergency number.

 Minimize movement of the head, neck and back.
Excessive movement can damage the spinal cord
irreversibly. Keep the victim as still as possible until
advance medical personnel arrive. Use a technique
called manual stabilization to minimize movement
of the head and neck.  Sprain
 Check for life-threatening conditions.
 Maintain open airways.
 Monitor consciousness and breathing.
  The person may describe it as pressure,
squeezing, tightness, aching or heaviness in the
chest.
 Many heart attacks start slowly as mild pain or
discomfort.

Heart Attack MGMT:

 Dislocation If you suspect that someone might be having a heart

attack, you should:

 Call the local emergency number immediately.

 Have the person stop what he or she is doing
and rest comfortably.
 Loosen any tight or uncomfortable clothing.
 Closely watch the person until advanced
medical personnel take over. Notice any changes
 Fracture in the person's appearance or behaviour. Monitor
the person's condition.
 Be prepared to perform CPR and use an AED, if
available, once the person loses
consciousness and stops breathing.
 Ask the person if he or she has a history of heart
disease.
 Offer aspirin if it is prescribed by his/her
physician for his/her condition and only if the
patient can swallow.
MGMT
Be calm and reassuring.
 Talk to bystanders and if possible the person to
get more information.
 Do not try to drive the person to the hospital
yourself.

Stroke

- A Stroke is a disruption of blood flow to a part of

the brain which may cause permanent damage to the
brain tissue

Causes:
MEDICAL EMERGENCIES
Heart Attack
- Heart attack, also called myocardial infarction,
occurs when the blood and oxygen supply to the
heart is reduced causing damage to the heart
muscle and preventing blood from circulating
effectively. It is usually caused by coronary heart
disease.
 A blood clot (thrombus or embolus), that forms
or lodges in the arteries that supply blood to the
brain.
 Bleeding from a ruptured artery in the brain is
caused by a head injury, high blood pressure, or
an aneurysm.
 Fat deposits lining an artery (atherosclerosis)
A tumor or swelling from a head injury may
compress an artery.

S/SX:

 Chest pain, discomfort or pressure.

 The pain associated with a heart attack can
range from
discomfort to an unbearable crushing sensation
in the chest.
 Although hyperglycemia and hypoglycemia are
different conditions, their major signals are similar.
These include:

 Changes in level of consciousness, including

dizziness, drowsiness and confusion.
 Irregular breathing
 Abnormal pulse (rapid or weak).

Diabetic Emergency MGMT

 First, check and determine if there are any life-

Stroke MGMT
Recognize the "signals" and take action:
 Call the local emergency number immediately.
Minutes count!
 Have the person stop what he or she is doing and
have them rest comfortably by sitting or lying
down.
 Give the victim supportive care and reassurance.
 Be prepared to perform CPR if the victim becomes
unresponsive
threatening conditions.
 A person with diabetes who is experiencing a
diabetic emergency must be instructed to test his or
her blood glucose level.
 A victim experiencing a diabetic emergency due to
hypoglycemia must be encouraged to treat
himself/herself with food or drink that contains
sugar. The same action is advised if the condition
still is to be determined or still remains unknown
(Are they hypoglycaemic or hyperglycaemic?).
 If the diabetic person is conscious and is able to
swallow and then states that they need
 sugar, give hisugar or orange juice.
Seizure

- When the normal functions of the brain are

disrupted by injury, disease, fever, poisoning or
infection, the electrical activity of the brain
Diabetic Emergency becomes irregular. This irregularity can cause a
loss of body control known as a seizure.
- Caused by imbalance between sugar and insulin
in the body.

Types and Causes:

1. Too much sugar in the blood(hyperglycemia):

The person may not have taken enough insulin
or may be reacting adversely to a large meal that
is high in carbohydrates.
2. Too little sugar in the blood (hypoglycemia):
The person may have taken too much insulin,
eaten too little, or has suffered from
overexertion. Extremely low blood sugar levels
can quickly become life threatening.

Signs and Symptoms: Seizure Emergency MGMT

 Reassure the victim that you are going to help.

 Remove nearby objects that might cause injury.
 Protect the victim's head by placing a thinly folded
towel or piece of clothing beneath it. Do not restrict
the airway in doing so.
 Do not hold or restrain the patient when a seizure is
in progress.
 Do not place anything between the victim's teeth or
put anything in the victim's mouth.
 Take care to ensure that the victim will not swallow
his/her tongue.
 Loosen clothing and fan the victim if the seizure was
caused by a sudden rise in
body temperature. Do not cool the victim by
splashing cold water or rubbing alcohol on his/her
body.
 Ensure that the victim's airway is open and check for
breathing and other injuries once the seizure is over.
 Stay and watch over the victim until the victim is
fully conscious.
Anaphylaxis
- Severe allergic reaction that is usually life-
threatening
Signs and Symptoms:
Anaphylaxis usually occurs suddenly and within
seconds or minutes after contact with the substance.
The skin or area of the body that comes in contact
with the substance usually becomes swollen and
turns red.
Other signals include the following:
 Difficulty in breathing, wheezing or shortness of
breath
 Tight feeling in the chest and throat
 Swelling of the face, throat or tongue
 Weakness, dizziness or confusion
 Rashes or hives
 Low blood pressure ⚫ Shock
Causes:
The most common antigens that often cause reactions
for allergic people are the following:
 Bee or insect veno,
 Pollen
 Animal dander
 Later
 Certain antibiotics and drugs
 Certain foods like nuts, peanuts, shellfish and
dairy products
Anaphylaxis Emergency MGMT
If you suspect anaphylaxis,
 Call the local emergency number.
 Calm and reassure the person.
 Help the person to rest in the most comfortable
position for breathing. This is usually via a sitting
position.
 Monitor the person's breathing. Look for any
changes in thei condition.
 Assist the person with the use of a prescribed
epinephrine auto-injector.
 Give this to the individual if available.
 Give care for life-threatening emergencies.
 Document any changes in the person's condition
over time.
Fainting
- Fainting is a partial or complete loss of
consciousness resulting from a temporary
reduction of blood flow to the brain.
Causes
Fainting can be triggered by:
 An emotionally stressful event
. Pain
 Specific medical conditions such as heart
disease;
 Standing for long periods of time or
overexertion.
 Pregnant women and the elderly are more likely
than others to faint when suddenly changing
positions. This could occur when moving from a
sitting or lying position or when standing up.
Fainting Emergency MGMT
 Position the victim on his or her back. Elevate
the legs about twelve inches to keep blood
circulating to the vital organs.
 Keep the victim in a lying position, especially
when unsure of the victim's condition or if
movement is painful to him/her.
 Loosen any restrictive clothing, such as a tie or a
buttoned-up collar.
 Check for any other life-threatening and non-
life-threatening conditions.
  Do not give the victim anything to eat or drink.
Do not slap the victim or splash water on
- Heat exhaustion is a milder form of heat-related
illness that can develop after exposure to high
his/her face. Splashing water on the victim
temperatures. This may also be a result of
could cause the victim to suck in water through
inadequate fluid intake or the insufficient
the mouth. replacement of fluids.

Heat Exhaustion MGMT

 Remove the patient from the hot environment. Fan

the body, place ice bags, or spray water on the skin.
 Start oral rehydration with a beverage containing
salt, or make them drink an Oral Rehydration
Solution (ORS).

ENVIRONMENTAL EMERGENCIES

Heat Cramps

- Heat cramps are painful involuntary muscle

cramps that can occur during and after exercise
or work in a hot environment.

Heat Cramps MGMT

Heat Stroke
 Remove the patient from the hot environment.
 Encourage the patient to drink a beverage containing
salt. If available, have the patient drink an Oral
Rehydration
Solution (ORS).
 If ORS packets are not available, make an oral
rehydration solution
Signs and Symptoms:
 Stretch the affected muscle and massage the area
once the spasm has passed.
Heat Exhaustion
- Heat stroke is a form of hyperthermia.
Prolonged exposure to high temperatures can
contribute to failure of the body's temperature
control system.
 Strange behavior, headaches, dizziness,
hallucinations, confusion, agitation,
disorientation, and coma.
High body temperature.
 Absence of sweating.
 Red, hot, dry and flushed skin. Rapid pulse and
difficulty breathing. Nausea, vomiting, fatigue
and weakness.

Heat Stroke MGMT

 Call or have someone call the local emergency

number
 Move the person into a cool place, a shaded area, or
an air- conditioned room.
 Cool the patient immediately by immersing him/her
in water. Make the water level reach the patient's
chin.
If water immersion is not possible or is delayed, the
following actions can be performed:
 Douse the patient with copious amounts of cold
water, spray the patient with water, fan the patient,
or cover the patient with ice towels or surround the
patient with ice bags.
 Respond to any life-threatening conditions that
may come about.
Hypothermia
- Hypothermia is the general cooling of the entire
body. In hypothermia, body temperature drops
below 35° C. As the body cools, an abnormal
heart rhythm (ventricular fibrillation) may
develop and the heart eventually stops.
Hypothermia MGMT
 Gently move the person to a warm place.
 Care for any life-threatening conditions.
 Call the local emergency number.
Remove any wet clothing and dry the person.
 Warm the person by wrapping him/her in
blankets or by replacing the
person's clothes with dry clothing (passive re-
warming).
 If available, apply heat pads or other heat
sources to the body. Hot water bottles and
chemical hot packs may be used, but first wrap
these in a towel or blanket before applying.
 Do not warm the person too quickly, such as by
immersing him or her in warm water. Rapid
warming may cause dangerous heart rhythms.
 If the person is alert, give warm liquids that do
not contain alcohol or caffeine. Monitor ABCs
and continue to warm the victim until EMS
personnel arrive. Be prepared to perform CPR if
necessary.
TRIAGING
Triage
- Triage is a management process for sorting
casualties into groups based on their need for
priority treatment or evacuation to definitive
care.
Mass Casualty Incident
- A mass casualties incident results in an
imbalance between assistance needs and the
help
available. The number of casualties and the
severity of their injuries exceed the human and
material resources available in the casualty-care
chain.
Concepts and Principles
 The decisions involved in triage are the most
difficult in all health care. However, choices are
made to achieve the greatest good not for any
particular individual but for the greatest number of
people.
 Adherence to general guidelines will ensure the best
matching of patient conditions with available
resources.
 Triage decisions must not be questioned to avoid
confusion.
 Triage is only a "snapshot" of the casualty's
condition at the time of assessment. Priority
categories may change as time goes by.
 The most experienced first aider arriving at the
scene becomes the triage officer.

Triage Categories and Priorities

There are four common triage categories. They can be

remembered using the mnemonic IDME, which stands
for:

Immediate (red-tag) - These are life-threatening

conditions that are treatable at least for a time. This is
achieved through immediate and simple measures such as
airway and gross hemorrhage control. Immediate case
signs include airway an breathing difficulties, uncontrolled
or severe bleeding, decreased mental status, patients with
severe medical problems, shock (hypoperfusion), and
severe burns.

Delayed (yellow-tag) - These are major but not

immediately life-threatening conditions where some delay
is acceptable. Delayed case signs include: burns without
airway problems, major or multiple bone or joint injuries
and back injuries with an without spinal cord damage.

Minimal (green-tag) - These minor injuries require

minimal surgical care. These are injuries for which an
indefinite wait is possible, if not desirable. Casualties are
often classified as the walking wounded. These casualties
should be transported to a space away from the main
triage and immediate treatment area to avoid crowding
and confusion.

Expectant (black-tag) - These are severe conditions that

nedical and/or surgical cares can no longer help. These
onditions are often classified as having little hope of
recovery.