Hil Ncii - Common - Bandong

COMPETENCY STANDARDS
HILOT (WELLNESS MASSAGE) NC II
This HILOT (WELLNESS MASSAGE) NC II Qualification consists of competencies

that a person must achieve to plan the hilot wellness program of client/s, provide pre-
service to client/s, apply hilot wellness massage techniques and provide post-advice
on post-services to clients.
The Units of Competency comprising this Qualification include the following:
Unit Code BASIC COMPETENCIES

500311105 Participate in workplace communication
500311106 Work in team environment
500311107 Practice career professionalism
500311108 Practice occupational health and safety procedures
Unit Code COMMON COMPETENCIES

HCS323201 Implement and monitor infection control policies and procedures
HCS323202 Respond effectively to difficult/challenging behavior
HCS323203 Apply basic first aid
HCS323204 Maintain high standard of patient / client services
Unit Code CORE COMPETENCIES

HCS222301 Plan the hilot wellness program of client/s
HCS222302 Provide pre-service to hilot client/s
HCS222303 Apply hilot wellness massage techniques
HCS222304 Provide post advice and post-services to hilot clients
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HILOT (WELLNESS MASSAGE) – LEVEL II

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HCS323201
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INFORMATION SHEET 1.1-1
“INDUSTRY CODE OF PRACTICE”
INTRODUCTION
It is alarming to know that, after testing, all these kitchens had meth
residues that exceed guideline levels, one by as much as 2000 times! Since
meth is an invisible contaminant simply looking at a property will not
indicate this, only testing will. How those tests are undertaken and reported
on can have a profound effect on properly identifying the extent of the meth
problem. A Code of Practice will increase certainty and confidence in the
services being provided.
There are either none or low barriers-to-entry into the meth testing and
decontamination space. There are no requirements for training either but
there is the potential for money to be made. The result can be an increasing
number of less scrupulous operators delivering services of wildly varying
quality. This reality can negatively influence those who want to see the
problem of meth contaminated property go away.
Once a positive case of COVID-19 has been identified, it is followed up with

contact tracing, a procedure which identifies, monitors and supports a
confirmed or probable case‘s close contacts, or individuals, who have been
exposed to and possibly infected with the virus. These individuals are the
case‘s ―contacts,‖ and they will be notified of the exposure by a health
department official.
Case investigations identify and investigate patients with confirmed and

probable diagnoses of COVID-19. A health department worker talks with the
patient to help them recall everyone they have had close contact with during
the time they may have been infectious.
A person is considered to have close contact if they are within six feet of an
infected person for at least 15 minutes. An infected person can spread
COVID-19 starting about 48 hours (two days) before they experience
symptoms or test positive for COVID-19, according to the CDC.
Why is contact tracing important?
Contact tracing is a mitigation strategy meant to slow the spread of COVID-

19. It lets individuals know they may have been exposed to COVID-19 and
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should monitor their health for signs and symptoms of the virus. It also
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helps those who may have been exposed get tested and asks individuals to
self-quarantine if they have COVID-19 or have been in close contact.
By identifying those who have been exposed, measures can be taken to self-
quarantine, which will prevent additional exposure of the virus in the event
that the virus was contracted during the exposure.
What to expect with contact tracing?
You may be contacted by a contact tracer if you have been diagnosed with a
confirmed case of COVID-19 or if you have been in close contact with
someone who has tested positive for COVID-19. A health department worker
will call you asking for information about your recent contacts.
If you test positive, a public health worker may call to check on your health
and ask who you have been in contact with and where you spent time while
you were sick and/or infectious. Think about who you have been around
and all the places you have been, including work, school, restaurants, stores
and car rides.
What you share is confidential and your personal and medical information
will be kept private. The contacts you give will only be notified of their
exposure and not given your name.
Please note: Health department staff will not ask for money, Social Security
numbers, bank account information, salary information or credit card
numbers.
Once contacts have been identified, you will be asked to self-isolate if you
are not already doing so. This means staying at home in a specific room
away from other people and pets and using a separate bathroom if possible.
Continue to monitor your health and seek medical care if symptoms worsen
or become severe.
SOURCE
https://news.nau.edu/contact-tracing-covid19/#.YJamtrUzbIU
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SELF CHECK 1.1-1
Choose the letter of the correct answer
1. A written statement of policies and principles that guides the behavior of

all employees is called…
a. code of ethics
b. word of ethics
c. ethical dilemma
d. None of the above
2. An empirical inquiry into the actual rules or standards of a particular

group is…
a. normative justice
b. descriptive justice
c. interpersonal justice
3. The HR policy which is based on the philosophy of the utmost good for
the greatest number of people is covered under the…
a. utilitarian approach
b. approach based on rights
c. approach based on justice
4. Which of the following is not usually the objective of a code of ethics?

a. to create an ethical workplace
b. to evaluate the ethical components of the proposed actions of the
employees
c. to improve the public image of the company
d. to enhance the profits of the business continuously 6
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ANSWER KEY 1.1-1
1. A
2. B
3. A
4. D
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“HAZARDS AND THE OUTCOMES OF INFECTION
RISK ASSESSMENTS”
INTRODUCTION
A risk assessment is a thorough look at your workplace to identify those

things, situations, processes, etc. that may cause harm, particularly to
people. After identification is made, you analyze and evaluate how likely and
severe the risk is. When this determination is made, you can next, decide
what measures should be in place to effectively eliminate or control the
harm from happening.
An infection risk assessment considers potential hazards and prioritizes

them to better guide goal-setting and strategy development. To understand
which risks pose the greatest threats to your facility, you must assess your
current operations. Why is an Infection Control Risk Assessment Important?
Risk assessment – the overall process of hazard identification, risk analysis,

and risk evaluation.
Hazard identification – the process of finding, listing, and characterizing

hazards.
Risk analysis – a process for comprehending the nature of hazards and

determining the level of risk.
Notes:
(1) Risk analysis provides a basis for risk evaluation and decisions about
risk control.
(2) Information can include current and historical data, theoretical analysis,
informed opinions, and the concerns of stakeholders.
(3) Risk analysis includes risk estimation.
Risk evaluation – the process of comparing an estimated risk against given

risk criteria to determine the significance of the risk.
Risk control – actions implementing risk evaluation decisions.

Note: Risk control can involve monitoring, re-evaluation, and compliance
with decisions.
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Why is risk assessment important?
Risk assessments are very important as they form an integral part of an
occupational health and safety management plan. They help to:
 Create awareness of hazards and risk.

 Identify who may be at risk (e.g., employees, cleaners, visitors,
contractors, the public, etc.).
 Determine whether a control program is required for a particular
hazard.
 Determine if existing control measures are adequate or if more should
be done.
 Prevent injuries or illnesses, especially when done at the design or
planning stage.
 Prioritize hazards and control measures.
 Meet legal requirements where applicable.
Assessing the Population

 Each organization serves different types of patients who are at varied
risks for health outcomes (both negative and positive)
 Development of surveillance systems should be based on evaluation of
interest of population
 Target to populations at risk for the outcomes of greatest importance
Organization and Patient Population Assessment

 Relative frequency of event
 Cost of negative outcome (treatment, LOS, mortality, severity
measures, and litigation, or public relations)
 Customer needs
 Community served
 Organizational mission and strategic goals
 Potential for improvement
 Meet regulatory requirements
Selecting the outcome or process for surveillance

 The choice of outcomes or process to be measured defines the
surveillance strategy
 Outcome is the result of care or performance
 Process is a series of steps taken to achieve an outcome
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Infection control risk assessment
How well prepared is the organization if the risk occurs
 Poorly
 Fairly well
 Well
Risk Score
 Assign a numerical value to each of the above
 Add or multiply
 Scores with highest number is prioritized.
Update no less than annually; use as a tool to evaluate your infection

prevention and control program and goals
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Boots on the ground
Risk assessment not produced in the IP‘s office

Multi-disciplinary team approach
 Infection Prevention
 Employee Health
 Pharmacy
 Lab
 Clinical Staff
 Engineering
Open forum/discussion
Agenda, Leader, facilitator, recorder
Collaborative Tools for Learning

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What are the infection prevention goals??
The Joint Commission

 Limit the transmission of infections associated with procedures
 Hand Hygiene
 Limit the transmission of infections associated with medical devices
 Limit unprotected exposure to patient, families and visitors
 Address prioritized risk
SOURCE
https://www.ccohs.ca/oshanswers/hsprograms/risk_assessment.html
https://spice.unc.edu/wp-content/uploads/2017/05/03-Infection-
Prevention-Risk-Assessment-Application.pdf
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SELF CHECK 1.1-2
Choose the letter of the correct answer.
1. The process of finding, listing, and characterizing hazards.

a. Risk assessment
b. Hazard identification
c. Risk analysis
d. Risk evaluation
2. The process of comparing an estimated risk against given risk criteria to

determine the significance of the risk.
a. Risk assessment
c. Risk analysis
d. Risk evaluation
3. Actions implementing risk evaluation decisions.

a. Risk assessment
c. Risk analysis
d. Risk control
4. The overall process of hazard identification, risk analysis, and risk

evaluation
a. Risk assessment
c. Risk analysis
d. Risk control
5. A process for comprehending the nature of hazards and determining the

level of risk.
a. Risk assessment
c. Risk analysis
d. Risk control
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ANSWER KEY 1.1-2
1. B
2. D
3. D
4. A
5. C
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“THERAPEUTIC COMMUNICATION”
INTRODUCTION
Therapeutic communication is defined as the face-to-face process of

interaction that focuses on advancing the physical and emotional well-being
of a patient. Nurses use therapeutic communication techniques to provide
education and support to patients, while maintaining objectivity and
professional distance. There are a variety of techniques that may be used to
engage in therapeutic communication with a patient, including the use of
open-ended questions, acknowledgment and acceptance, using silence,
asking for clarification, active listening, reflecting, and summarizing.
Therapeutic communication is a collection of techniques that prioritize the

physical, mental, and emotional well-being of patients. Nurses provide
patients with support and information while maintaining a level of
professional distance and objectivity. With therapeutic communication,
nurses often use open-ended statements and questions, repeat information,
or use silence to prompt patients to work through problems on their own.
Active Listening, Touch, & Space

A critical component of therapeutic communication is the art of active
listening. Active listening involves both nonverbal and verbal
communication. When actively listening, a nurse needs to hear and
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understand what the client is saying. That is, to some extent, the easy part.
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What's even more important is that the nurse properly interprets the

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meaning behind what the patient is verbalizing. In other words, what is the
patient really saying?
Active listening involves verbal communication, such as when a nurse

paraphrases what the client has said. It also includes nonverbal types of
communication, such as good eye contact that is neither absent nor
prolonged, as well as silence. An example of silence in active listening would
be giving a patient some time to think through their thoughts if you believe
they need it.
Another kind of nonverbal therapeutic communication technique is touch.

This can give the patient the sense that you care for them. However, you
must be careful with this. It's important that you are culturally aware as
you engage in therapeutic communication with your patient. For instance,
in some cultures, touch between strangers of opposite genders is strictly
frowned upon.
Similarly, another important nonverbal communication technique is that of

personal space. Different cultures and individual people will respond in
various ways to the space between themselves and a nurse. For some, it's
important the nurse is physically close to them. For others, the old saying
'too close for comfort' rings true.
Therapeutic Communication Techniques
There are a variety opens of therapeutic communication techniques nurses

can incorporate into practice.
Using Silence
At times, it‘s useful to not speak at all. Deliberate silence can give both
nurses and patients an opportunity to think through and process what
comes next in the conversation.
It may give patients the time and space they need to broach a new topic.
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Nurses should always let patients break the silence.

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Accepting
Sometimes it‘s necessary to acknowledge what patients say and affirm that
they‘ve been heard.
Acceptance isn‘t necessarily the same thing as agreement; it can be enough

to simply make eye contact and say ―Yes, I understand.‖ Patients who feel
their nurses are listening to them and taking them seriously are more likely
to be receptive to care.
Giving Recognition
Recognition acknowledges a patient‘s behavior and highlights it without
giving an overt compliment.
A compliment can sometimes be taken as condescending, especially when it

concerns a routine task like making the bed. However, saying something like
―I noticed you took all of your medications‖ draws attention to the action
and encourages it without requiring a compliment.
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Offering Self
Hospital stays can be lonely, stressful times; when nurses offer their time, it
shows they value patients and that someone is willing to give them time and
attention.
Offering to stay for lunch, watch a TV show, or simply sit with patients for a
while can help boost their mood.
Giving Broad Openings

Therapeutic communication is often most effective when patients direct the
flow of conversation and decide what to talk about.
To that end, giving patients a broad opening such as ―What‘s on your mind
today?‖ or ―What would you like to talk about?‖ can be a good way to allow
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patients an opportunity to discuss what‘s on their mind.

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Active Listening
By using nonverbal and verbal cues such as nodding and saying ―I see,‖
nurses can encourage patients to continue talking.
Active listening involves showing interest in what patients have to say,

acknowledging that you‘re listening and understanding, and engaging with
them throughout the conversation. Nurses can offer general leads such as
―What happened next?‖ to guide the conversation or propel it forward.
Seeking Clarification
Similar to active listening, asking patients for clarification when they say
something confusing or ambiguous is important.
Saying something like ―I‘m not sure I understand. Can you explain it to me?‖
helps nurses ensure they understand what‘s actually being said and can
help patients process their ideas more thoroughly.
Placing the Event in Time or Sequence

Asking questions about when certain events occurred in relation to other
events can help patients (and nurses) get a clearer sense of the whole
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picture. It forces patients to think about the sequence of events and may
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prompt them to remember something they otherwise wouldn‘t.

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Making Observations
Observations about the appearance, demeanor, or behavior of patients can
help draw attention to areas that might pose a problem for them.
Observing that they look tired may prompt patients to explain why they
haven‘t been getting much sleep lately; making an observation that they
haven‘t been eating much may lead to the discovery of a new symptom.
Encouraging Descriptions of Perception

For patients experiencing sensory issues or hallucinations, it can be helpful
to ask about them in an encouraging, non-judgmental way. Phrases like
―What do you hear now?‖ or ―What does that look like to you?‖ give patients
a prompt to explain what they‘re perceiving without casting their
perceptions in a negative light.
Encouraging Comparisons
Often, patients can draw upon experience to deal with current problems. By
encouraging them to make comparisons, nurses can help patients discover
solutions to their problems.
Summarizing
It‘s frequently useful for nurses to summarize what patients have said after
the fact. This demonstrates to patients that the nurse was listening and
allows the nurse to document conversations. Ending a summary with a
phrase like ―Does that sound correct?‖ gives patients explicit permission to
make corrections if they‘re necessary.
Focusing
Sometimes during a conversation, patients mention something particularly
important. When this happens, nurses can focus on their statement,
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prompting patients to discuss it further. Patients don‘t always have an

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objective perspective on what is relevant to their case; as impartial
observers, nurses can more easily pick out the topics to focus on.
Reflecting
Patients often ask nurses for advice about what they should do about
particular problems or in specific situations.
Nurses can ask patients what they think they should do, which encourages
patients to be accountable for their own actions and helps them come up
with solutions themselves.
Confronting
Nurses should only apply this technique after they have established trust. It
can be vital to the care of patients to disagree with them, present them with
reality, or challenge their assumptions. Confrontation, when used correctly,
can help patients break destructive routines or understand the state of their
situation.
Voicing Doubt
Voicing doubt can be a gentler way to call attention to the incorrect or
delusional ideas and perceptions of patients. By expressing doubt, nurses
can force patients to examine their assumptions.
Offering Hope and Humor

Because hospitals can be stressful places for patients, sharing hope that
they can persevere through their current situation and lightening the mood
with humor can help nurses establish rapport quickly. This technique can
keep patients in a more positive state of mind.
SOURCE
https://www.rivier.edu/academics/blog-posts/17-therapeutic-
communication-techniques/
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SELF CHECK 1.2-1
1. Therapeutic communication is often most effective when patients direct

the flow of conversation and decide what to talk about.
a. Communication
b. Engagement
c. Face to Face
d. Giving Broad Openings
2. A compliment can sometimes be taken as condescending, especially when

it concerns a routine task like making the bed.
a. Giving recognition
b. Offering self
c. Face to Face
d. Using silence
3. It may give patients the time and space they need to broach a new topic.
b. Offering self
c. Face to Face
d. Using silence
4. Can be a gentler way to call attention to the incorrect or delusional ideas

and perceptions of patients.
b. Offering self
c. Voicing doubt
d. Using silence
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ANSWER KEY 1.2-1
1. D
2. A
3. D
4. C
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“INFECTION CONTROL POLICIES AND PROCEDURES”
INTRODUCTION
The purpose for putting policies and procedures in place for Infection
Control is to ensure employees, clients and families are protected against
infectious diseases and infections by providing guidelines for their
investigation, control and prevention.
1. Hand Hygiene
Hand hygiene is now regarded as one of the most important element of

infection control activities (Marthur, 2011), and is required even if gloves are
worn. Most health care- associated infections (HAIs) are preventable through
good hand hygiene – cleaning hands at the right times and in the right way.
(WHO, 2012)
Hands are the most common means in which microorganisms, particularly

bacteria, can be spread and subsequently cause infection, especially for
those patients who are most susceptible.
Staff must consider the potential/actual hazards that have or might be

encountered during the course of their duties and how this subsequent
hazard may present as potential/actual contamination of their hands and
risk to service users, visitors and other staff. This assessment must inform
the hand hygiene procedure undertaken by staff to eliminate the risks of
cross-infection.
Staff must assume that every person they encounter could be carrying
potentially harmful microorganisms that could be transmitted and cause
harm to others. As such, staff must carry out effective hand hygiene at the
correct point in care as a standard infection control precaution. Hand
hygiene is one of the elements of Standard Infection Control Precautions.
Everyone has an important part to play in improving patient safety and

contributing to breaking the chain of infection at every opportunity.
Your Five Moments of Hand Hygiene

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The World Health Organisation (WHO) has produced a model (5

Moments for ‗Hand Hygiene at the point of care‘) explaining when
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hands should be decontaminated as described in the table below. Hands

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must be decontaminated immediately before each and every episode of
direct service user contact or care and after any activity or contact that
could potentially result in hands being contaminated.
Before Service User Contact WHEN? Clean your hands before touching a
service user.
WHY? To protect the service user against
harmful germs carried on his/ her body.
Before an Aseptic Non Touch WHEN? Clean your hands immediately before
Technique task is undertaken. any aseptic task.
WHY? To protect the service user against harmful
germs, including the service user’s own germs from
entering his/ her body.
After body fluid exposure. WHEN? Clean your hands immediately after a risk
exposure to bodily fluids (and after glove
removal)
WHY? To protect yourself and the healthcare
environment from harmful patient germs.
After service user contact. WHEN? Clean your hands after touching a service
user and his/ her immediate surroundings when
leaving.
WHY? To protect yourself and the health
care environment from harmful service user germs.
After contact with service WHEN? Clean your hands after touching any object or
user surroundings. furniture in the service user’s immediate surroundings
when leaving – even without touching the service user.
WHY? To protect yourself and the
healthcare environment from harmful service user
germs.
Or in the diagram as seen below:
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To fully understand the Five Moments staff need to be aware of the concept of the
‗service user zone‘. Staff need to clean their hands at the ‗Point of Care‘ and also
when they enter the service user‘s ‗zone‘ and when they leave it.
Health care workers must decontaminate their hands before and after all contact
with service users and whenever hands are visibly soiled. It is best to think of this
in terms of:
• What activity has just been undertaken?
• What activity is about to be undertaken?
Principles
Hand hygiene can be achieved by hand washing with soap, by the use of alcohol
based hand rub or by the use of hand sanitizing wipes.
Alcohol-based hand rub is an acceptable alternative to hand washing between

caring for different service users or between different caring activities for the same
service user as long as the hands are not grossly soiled, they must be free of dirt
and organic material. The product needs to be applied to dry hands using the ‗Six
Stage‘ Technique (Appendix 1) until it has evaporated (dry).
The following technique should be used when using hand sanitizing wipes:
• Liquid soap/skin disinfectant

• Warm running water
• Friction
• Thorough drying
• Disposable paper towels
Hands should be washed with liquid soap: -

• Before commencing duty and at the completion of duty span
• Before and after caring for any patient
• Hands visibly soiled or grossly contaminated with dirt or organic matter
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• Before the serving of meals and drinks

• Before the administration of medication
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• After toilet use
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Standard Infection Control Precautions
Standard precautions are a set of practices which are designed to prevent

cross transmission from recognized and unrecognized sources of infection.
These sources of (potential) infection include blood and other body fluids or
items in the care environment which are likely to be contaminated.
There are a number of elements to standard infection control

precautions:
• Hand Hygiene
• Gloves
• Personal protective equipment including gloves, masks and face
protection
• Safer sharps practice and injection safety
• Decontamination of equipment
• Environmental hygiene
• Clinical waste
• Laundry
• Respiratory hygiene and cough etiquette
• Management of blood and body fluids
Body fluids include:

• Blood
• Urine
• Cerebrospinal Fluid (CSF)
• Peritoneal Fluid
• Pleural Fluid
• Synovial Fluid
• Amniotic Fluid
• Semen
• Vaginal Secretions
• Saliva
• Vomit
• Any other body fluid containing visible blood e.g. urine, faeces, unfixed
tissue and organs.
The purpose of this document is to set down the principles of standard

precautions and to ensure that they are the minimum level of precautions
used when providing care for all patients. They protect both staff and service
users by reducing the opportunity for the transmission of micro-
organisms.(WHO,2006)
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2. Wear Gloves
Similar to hand hygiene, wearing gloves and properly disposing of them

plays an important part in reducing the spread of HAIs. Be sure to mention
the following in your policy:
 Wear gloves when handling any body related materials, including
blood, secretions, excretions, membranes, body fluids, etc.
 Change gloves between tasks
 Properly discard gloves after completion of task and perform proper
hand hygiene protocol
3. Wear a Gown
It‘s important to protect your skin and avoid soiling your clothing, as it is
likely that clothing cannot be discarded if it should happen, and that‘s
where gowns come in. Wearing a gown is an easy way to not only ensure
that your clothing lives to see another day away from the cleaners but as
they can easily be removed and will help avoid the spread of infectious
diseases.
Wear gowns in any instances where splashes or spraying of secretions,

excretions, blood or bodily fluids might be present.
Remove gowns as soon as possible and perform hand hygiene.
4. Protect your Face
Our faces are portals for infectious diseases to make their way into our
bodies. This is why it is important to protect our eyes, nose, and mouth
against splashes or sprays of blood, fluids, secretions, etc.
5. Prevention of needlestick injuries
Just like hand hygiene policies are a no-brainer, this one may seem like one
too. However, sometimes it‘s good to just be reminded. Being around
surgical instruments and needles can be pretty dangerous as well. Having a
set of policies in place outlining how to handle instruments or dispose of
needles may be the refresher some people need to stay safe.
6. Respiratory hygiene and cough etiquette

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Flu season isn‘t the only time we should be reminding staff and patients
about this policy. Having a set of instructions in place may be the gentle
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nudge in the right direction people need to keep others healthy. Beyond
covering up your nose and mouth with tissues or a mask when coughing
and sneezing and performing proper hand hygiene frequently, hospitals
should:
Place patients with respiratory ailments away from common areas

Post signs alerting people entering these areas to take extra care and remind
them to perform hand hygiene when leaving
Post signs instructing those with ailments of proper hygiene etiquette
Make preventative tools available for staff and patients to take advantage of
7. Regular cleaning
Ensure policies are in a place where common areas and areas with
infectious patients are regularly cleaned and frequently touched surfaces are
disinfected once it is recognized that they have been infected.
8. Linens
They may seem harmless, but the truth is they could be carrying the
pathogens that we have been trying so hard to avoid. Creating a policy
where staff must wear gloves, gowns, and facial protection when handling
linens, as well as disposing of the protective clothing immediately after use
can go a long way in protecting staff from contracting an HAI.
9. Waste Disposal
Having a waste management policy in place is also a crucial procedure to

ensure staff are aware of. Most importantly, your policy should include how
to properly dispose of waste that has been contaminated with blood, human
tissues, and bodily fluids safely.
10. Patient Care Equipment
Often times the equipment used to care for patients can become soiled.
Having a policy in place where staff must clean and disinfect this equipment
regularly and upon recognizing that the equipment has been soiled is
another small step in the right direction of infection control and prevention.
While it‘s important that the right policies and procedures be implemented,
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it is equally important that policies are regularly promoted to maintain

momentum. What‘s more, having an automated process that enables staff to
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access policies at the point of care quickly and easily can empower staff to

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take charge of adhering to hospital policies. Often times, teaming up with
your Quality and Risk Department(s) to promote a culture of safety is a key
step that shouldn‘t be overlooked, as creating a safe hospital is equally
important to them as it is to you.
SOURCE
https://www.policymedical.com/10-must-infection-control-policies/
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SELF CHECK 1.2-2
1. Is portals for infectious diseases to make their way into our bodies
a. Face
b. Hand
c. Neck
d. Head
2. It‘s important to protect your skin and avoid soiling your clothing, as it is
likely that clothing cannot be discarded if it should happen, and that‘s
where gowns come in…
a. Wear gloves
b. Wear gown
c. Hand hygiene
d. Respiratory hygiene and cough etiquette
3. This one seems like a no-brainer, we all know that good hand hygiene can
reduce the risk of flu, food poisoning, and other HAIs.
a. Wear gloves
b. Wear gown
c. Hand hygiene
4. Place patients with respiratory ailments away from common areas

a. Wear gloves
b. Wear gown
c. Hand hygiene
5. Properly disposing of them plays an important part in reducing the

spread of HAIs
a. Wear gloves
b. Wear gown
c. Hand hygiene
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ANSWER KEY 1.2-2
1. A
2. B
3. C
4. D
5. A
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“EMPLOYER’S COACHING AND SUPPORT”
INTRODUCTION
The role of a coach is extremely valued in athletics. But for some reason,
that belief rarely extends to the workplace. Managers are too often viewed as
overseers instead of mentors. In reality, coaching is just as essential in the
workplace as it is on the field or court.
Employee coaching is an important part of continuous performance

management. When managers maximize employee potential and surround
employees with supporting talent, they put their teams in a position to grow
and help the organization succeed.
1. Give employees regular, frequent feedback.
Employees crave constructive feedback from their managers, but don‘t

always get it. Your employees want to know how their performance is
viewed, what they‘re doing well, and what they need to improve.
Intentionally set aside time to provide feedback on employee performance.

Use one-on-one meetings and GOOD sessions as regular feedback periods.
Consider setting reminders in your calendar to consistently provide feedback
to each employee.
2. Create a culture of team feedback.
Contrary to popular belief, feedback shouldn‘t just come from the manager.
Employees should be encouraged to provide feedback to each other and to
you, their manager.
Strive to build a culture where 360 feedback is the norm. This creates an
ongoing dialogue that gives employees at all levels of the organization an
opportunity to be heard.
3. Push employees to their attainable limits.
While you don‘t want to overwhelm employees, motivating your team to get
out of their comfort zone can help them grow and perform at their highest
potential employees who demonstrate a lack of interest in their work are
much more likely to become disengaged.
In many cases, they need to be challenged and provided regular feedback

and recognition to grow and improve. Identify each employee‘s experience
and skillset, and have them take on new tasks or assignments that help
them expand. Be available and willing to help when questions arise.
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4. Be open to employee ideas.
Employee listening is an essential part of coaching. It opens you to different

concepts you hadn‘t previously thought of, and it makes employees feel
heard. When they feel their opinion is respected and valued, they‘re far more
likely to be engaged and push harder.
Build in opportunities to capture employee voice through one-on-ones,

feedback, and employee surveys. Listening to different perspectives from a
variety of venues can help you create a more complete picture of the
employee experience.
5. Encourage employees to learn from others.
No two employees are exactly alike. They come from different backgrounds
and have varying personalities, strengths, and weaknesses. Simply
connecting employees with their peers opens new possibilities and creates a
more connected workplace.
Encourage employees to interact frequently so they teach each other new

skills or approaches. Welcoming differing perspectives and asking for all
employees to contribute will help you foster a more diverse and inclusive
culture at work.
6. Ask employees for opinions.
Employees aren‘t the only ones who can learn from each other—you can too!
Keep an open mind during conversations and frequently source new ideas or
tactics from them. Collecting regular feedback from your employees shows
you‘re willing to listen and always looking to improve.
Simply asking for feedback creates an open dialogue and gives employees a
voice. This can make the workplace feel more like a democracy instead of a
dictatorship. Make sure you take notes and follow up once you‘ve heard
from your team.
7. Build confidence.
Confident employees are more likely to achieve their goals than those who
feel unsupported and misguided. As you coach employees and provide
feedback, it‘s critical that you instill them with confidence.
Look for opportunities to recognize employees for strong performance and

extra effort. Make sure you understand how employees like to be recognized
too, but always strive to make it public so that others in the organization
can take note. Acknowledging employees‘ contributions boosts their
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confidence and sets them up for success.

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COMMON COMPETENCY
8. Don't do employees' work for them.
When you notice an assignment is proceeding slowly or heading in the

wrong direction, you might be tempted to take it into your own hands and
simply complete it yourself. This might be beneficial in the short term, but
employees need to learn through trial and error.
Instead of taking the task off their hands, teach them how to handle the
situation by offering guidance. Ask leading questions and help them
navigate their way through the muck. Remember—a good coach gives their
team a pathway to success.
9. Tolerate and support failure.
Sometimes, things don‘t go according to plan. Mistakes will be made and

deals will fall through. It‘s just a part of work. But how you respond is what
really matters. Accepting failure and moving to the next task can create a
lower standard for performance expectations. But you don‘t want to crush
employees‘ spirits for their mistakes either.
Ask your employees to explain what went wrong and how they could have
performed better. Encourage them to consider what opportunities exist and
how they might improve in the future. Remain positive and solution-
oriented.
10. Recognize employees often.
Mistakes happen, and so do successes! Oftentimes, managers get caught up

in being a constructive coach instead of a celebratory one. When an
employee succeeds or goes over the top, let them know that you noticed.
Recognition can be as simple as a thank-you note, a cup of their favorite

coffee drink, or a shout-out during the next team meeting. Little
acknowledgements can go a long way toward securing buy-in and building a
stronger team.
11. Make a goals roadmap.
If you hope to get everyone pushing in the same direction, you need to show
them where to go. Goals are the clearest and most effective way to do so.
Sit down with employees to create personal goals that help them develop
and further their careers. Work to connect those goals to the over
benchmarks of the team and the organization as a whole. Aligning goals in
this way will give employees a clear picture of how their work contributes to
team and business success.
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12. Ask what you can do to help.
Good coaches don‘t just throw their players into a competition and say,
―figure it out.‖ They actively encourage their team and search for solutions
to help athletes succeed.
Let your employees know they can come to you with questions or concerns.
Use one-on-ones to understand the challenges they are facing and build a
plan together. You‘re there to help them, and they should feel comfortable
asking for advice and or assistance.
Employers' health and safety responsibilities
Employers have responsibilities for the health and safety of their employees
and any visitors to their premises such as customers, suppliers and the
general public. In addition to these duties, there are regulations to deal with
particular hazards and for industries where hazards are particularly high.
Health and safety regulations

The Health and Safety at Work (Northern Ireland) Order 1978 is the primary
piece of legislation covering work-related health and safety in Northern
Ireland. It sets out a lot of your employer's responsibilities for your health
and safety at work.
Additionally, specific regulations cover particular areas, including lead,

asbestos, chemicals, construction work, and gas safety. Visit the HSENI
website for the many ways in which they can help you with these particular
issues.
The Health and Safety Executive is responsible for enforcing health and
safety at work.
Risk assessments
Your employer has a 'duty of care' to make sure, as far as possible, your
health, safety and welfare while you're at work. They should start with a risk
assessment to spot possible health and safety hazards.
They have to appoint a 'competent person' with health and safety

responsibilities usually one of the owners in smaller firms, or a member of
staff trained in health and safety.
Businesses employing five or more people

For businesses employing five or more people, there must also be:
 an official record of what the assessment finds (your employer has to

put plans in place to deal with the risks)
 a formal health and safety policy which includes arrangements to
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protect your health and safety (you should be told what these are)
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COMMON COMPETENCY
Your employer's duty of care in practice
All employers, whatever the size of the business, must:
 make the workplace safe

 prevent risks to health
 ensure that plant and machinery is safe to use
 ensure safe working practices are set up and followed
 make sure that all materials are handled, stored and used safely
 provide adequate first aid facilities
 tell you about any potential hazards from the work you do - chemicals
and other substances used by the firm - and give you information,
instructions, training and supervision as needed
 set up emergency plans
 make sure that ventilation, temperature, lighting, toilet, washing and
rest facilities all meet health, safety and welfare requirements
 check that the right work equipment is provided and is properly used
and regularly maintained
 prevent or control exposure to substances that may damage your
health
 take precautions against the risks caused by flammable or explosive
hazards, electrical equipment, noise and radiation
 avoid potentially dangerous work involving manual handling (and if it
can't be avoided, take precautions to reduce the risk of injury)
 provide health supervision as needed
 provide protective clothing or equipment free of charge (if risks can't
be removed or adequately controlled by any other means)
 ensure that the right warning signs are provided and looked after
 report certain accidents, injuries, diseases and dangerous occurrences
to either the Health and Safety Executive for Northern Ireland or the
local authority, depending on the type of business
 Frequently Asked Questions (Health and Safety Executive
website)(external link opens in a new window / tab)
 Safe manual work
Making the workplace safe and healthy

So that the work premises provide a safe and healthy place to work, your
employer should:
 make sure that are properly ventilated, with clean and fresh air
 keep temperatures at a comfortable level (a minimum of 13 degrees
Centigrade where the work involves physical activity; 16 degrees
Centigrade for 'stinter' like offices - there's no maximum limit
 light premises so that employees can work and move about safely
 keep the workplace and equipment clean
 ensure that areas are big enough to allow easy movement (at least 11
38
cubic metres per person)

 provide workstations to suit the employees and the work
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COMMON COMPETENCY
 keep the equipment in good working order
 make floors, walkways, stairs, roadways safe to use
 protect people from falling from height or into dangerous substances
 store things so they're unlikely to fall and cause injuries
 fit open able windows, doors and gates with safety devices if needed
 provide suitable washing facilities and clean drinking water
 if necessary, provide somewhere for employees to get changed and to
store their own clothes
 set aside areas for rest breaks and to eat meals, including suitable
facilities for pregnant women and nursing mothers
 let employees take appropriate rest breaks and the right holiday
entitlement
 make sure that employees who work alone, or off-site, can do so safely
and healthily
 Working alone
 Workplace health, safety and welfare
 Rest breaks
 Holiday entitlements
Reporting injuries, diseases and dangerous occurrences

There is a legal obligation to report certain types of incident in the workplace
to the relevant authorities.
Employers, self-employed people, and people in control of premises have a

legal duty to report the following:
 work-related deaths
 major injuries or over-three-day injuries
 work related diseases
 dangerous occurrences (near miss accidents)
Reporting an accident
To report injuries, near misses, fires or explosions which have occurred as a
result of work on or near to electrical systems by others, or incidents arising
from leisure and other non-work activities in proximity to electrical plant, or
from equipment failure, use the form below:
SOURCE
https://www.quantumworkplace.com/future-of-work/12-rules-for-effective-
employee-coaching
https://www.nidirect.gov.uk/articles/employers-health-and-safety-
responsibilities
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SELF CHECK 1.2-3
1. The __________ _________ is a pattern in which the worker performs one

assignment well and then has the confidence to take on an even more
difficult assignment.
a. Work-peak syndrome
b. Competent syndrome
c. Success syndrome
d. Avoid-fail syndrome
2. To develop a proactive personality you can attempt to be more of a self-

starter and __________________.
a. Learn to say no
b. Learn to read people
c. Take more initiative to solve problems
d. Develop social skills
3. A mentor is likely to be able to help you in your career campaign in all of

the following ways except:
a. Harming your career
b. Providing coaching
c. Give emotional support
d. Provide guidance
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ANSWER KEY 1.2-3
1. The __________ _________ is a pattern in which the worker performs one
assignment well and then has the confidence to take on an even more
difficult assignment.
a. Work-peak syndrome
b. Competent syndrome
c. Success syndrome
d. Avoid-fail syndrome
2. To develop a proactive personality you can attempt to be more of a self-

starter and __________________.
a. Learn to say no
b. Learn to read people
c. Take more initiative to solve problems
d. Develop social skills
3. A mentor is likely to be able to help you in your career campaign in all of

the following ways except:
a. Harming your career
b. Providing coaching
c. Give emotional support
d. Provide guidance
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“SAFE WORK PROCEDURES”
INTRODUCTION
Safe work practices are generally written methods outlining how to perform
a task with minimum risk to people, equipment, materials, environment,
and processes. Safe job procedures are a series of specific steps that guide a
worker through a task from start to finish in a chronological order.
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What is Occupational Safety and Health (OSH)?
Occupational safety and health is a discipline with a broad scope involving

three major fields – Occupational Safety, Occupational Health and Industrial
Hygiene.
 Occupational safety deals with understanding the causes of accidents
at work and ways to prevent unsafe act and unsafe conditions in any
workplace. Safety at work discusses concepts on good housekeeping,
proper materials handling and storage, machine safety, electrical
safety, fire prevention and control, safety inspection, and accident
investigation.
 Occupational health is a broad concept which explains how the
different hazards and risks at work may cause an illness and
emphasizes that health programs are essential in controlling work-
related and/or occupational diseases.
 Industrial hygiene discusses the identification, evaluation, and control
of physical, chemical, biological and ergonomic hazards.
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Company’s rules and regulations manual
As you begin writing, or updating, your employee handbook, keep it simple,

straightforward and relevant to your particular business. Outline the
policies that affect your employees.
Here are six areas that can help you kick-start a strong employee handbook.
1. Code of conduct
Your business‘s code of conduct is the first place employees should look
when they have questions about ethics and compliance. It‘s a roadmap of
how they should act, and it speaks to your company culture.
Some of the basic information you‘ll want to include in your code of conduct
includes:
 Code of ethics
 Dress code and grooming standards
 Workplace safety
 Attendance requirements
Spell it all out for your employees. Set expectations and establish the
consequences for not meeting those expectations.
For example, if an employee is consistently late to work, you should be able

to refer them to their handbook for specifics on their working hours, as well
as the protocol you determine for excessive tardiness. Or, if male employees
are expected to wear suits and ties, but a rogue employee insists on
foregoing the tie, how willing are you to relax some rules?
Maybe you could offer casual Fridays as a compromise. Whatever you

decide, you‘ll set you and your staff up for success by including this
information in your employee handbook.
2. Communications policy
A clear communications policy may have been optional in the past, but it‘s
more important than ever in the current technological environment.
Do you provide your employees with laptops, cell phones and other devices?
Do you really know how those devices are being used? How often are your
employees using company equipment to surf the net, make personal phone
calls, store photos, text friends or post on social media?
Your communications policy should explicitly state your expectations of

appropriate use of devices and behavior on those devices. Employees should
have a clear understanding that when they use company equipment, they‘re
acting as a representative of your company. Tell them, for example, that
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COMMON COMPETENCY
Make sure they understand that other company policies, such as anti-
discrimination, anti-harassment and ethics policies extend to all forms of
communication and all devices.
3. Nondiscrimination policy
This is a must for any strong employee handbook. You want employees to
know that your organization will not tolerate discrimination or harassment
in any way, shape or form.
State and federal legislation brought on by the civil rights movement of the
1960s protects employees from discrimination based on factors not directly
related to the quality of their work. These include but are not limited to:
 Age
 Race/color
 Religion
 Pregnancy
 Disability
Laws prohibiting discrimination are enforced by the Equal Employment

Opportunity Commission.
Keep in mind that discrimination isn‘t always overt or on purpose. Even

good managers can slip and unintentionally discriminate among employees.
Are employees complaining about the perfect, five-star rating one employee
received on his review when no one else did? Maybe they believe it‘s because
he and his supervisor are lunch buddies.
Chances are, the manager is just trying to help his friend get the annual
salary increase – and doesn‘t realize he may be discriminating against the
rest of his team. Regardless, this is a huge area for potential liability, and a
strong handbook can be a good defense if charges are filed against your
company.
In the meantime, good managers aren‘t born – they‘re made. Make yours
aware of your policies and provide supervisory and leadership training on
nondiscrimination.
4. Compensation and benefits policy

Employees don‘t always remember all the perks you talked about during
their interviews. You can use your employee handbook to remind them
about employee benefits, including general information and vacation time.
You also want to cover your legal bases by explaining things like payroll
deductions, overtime, the Family and Medical Leave Act and the workers‘
compensation policy.
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Keep things simple and high-level, however. There are no absolutes in
business, and a change in circumstances, benefits or policies will mean you
need to update your employee handbook.
For instance, you might want to outline your benefit and compensation
philosophy without naming specific carriers or plan options.
You can also outline how often employees will receive performance reviews
without mentioning specific pay increases. You don‘t want to outline the
specifics of yearly merit increases and then find you can‘t provide them
because of business demands. Be careful about the details you include.
5. New hire and separation policy

Provide the basic terms of employment and what employees can expect if
and when they terminate, including:
 Eligibility for benefits – is there a waiting period? How long?

 Frequency of pay periods – weekly, bi-weekly, monthly?
 Transfers and relocation – if employees quit or move, how much notice
do you require? Do you provide relocation assistance for employees
who transfer to another office within the company?
 Referrals – do you offer monetary rewards to employees who refer
talent that you hire?
 At-will and discipline – do you have a progressive discipline policy? If
employees are terminated by you, are they paid for vacation time (if
not required by state law)?
6. Acknowledgment of receipt
Be sure your employees understand everything in your employee handbook,
and require that they sign an acknowledgment of that understanding. Make
two copies. Give one to the employee, and keep the other in their
employment file – whether it‘s a hard copy or electronic document.
Consider available technology, and decide in advance:

 Will you accept an electronic signature?
 Is your employee handbook available online?
 Can the online version of the handbook be printed?
If an employee termination becomes contentious, and policies are being

contested, having on file the employee‘s signed acknowledgment of receipt
can be your strongest defense.
Putting it all together

Your employee handbook is a manual of information that your employees
need to function within your organization. A good handbook will:
 Set the tone for your organization
 Summarize rules and policies that affect your company culture
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 Provide a consistent message for your employees

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COMMON COMPETENCY
You don‘t have to include the kitchen sink, but be sure to cover the
pertinent points that are relevant and applicable to your business.
For instance, a manufacturing firm may not have a critical need for a
communications policy. Likewise, if you have employees who travel for
business, address the issues surrounding that, e.g., per diems, expense
reimbursement, etc.
In addition to policies, your employee handbook should include information

about who to contact should an employee need to report policy violations.
Expect to update your handbook every one to two years. Be sure you include
key state and federal policies, and realize that new laws and regulations
mean revisions to your handbook to remain compliant.
Remember to always make sure your policies are clear and don‘t assume
that everyone will read their handbook cover to cover. Try to keep your
handbook to a maximum of 30 to 40 pages, if possible. If it‘s too long, it may
not get the attention it deserves.
Health and safety company protocol about COVID
All employees and workers shall:

1. Always practice personal protective measures such as regular hand
washing, wearing of face masks and face shield, physical distancing of at
least 1 meter, and avoiding crowded places.
47
2. Self isolate or just stay at home and not report to work if with COVID-19
like symptoms (fever, cough, sore throat, myalgia, flu-like illness). Inform
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COMMON COMPETENCY
3. Undergo risk exposure assessment and be subjected to contact tracing
procedure if with exposure to COVID-19 suspect, probable or confirmed
case, according to prescribed national guidelines set by the Department of
Health and local government and workplace policies.
4. Adopt an appropriate alternative work arrangement upon discussion with

and approval by your work supervisors subject to governing rules and
regulations and other local personnel guidelines.
5. Keep personal track of daily activities for easier history-taking when

contact tracing is needed.
6. Strictly follow and implement guidelines on infection control procedures,

waste management, and all other guidelines on managing visitors and
clients.
7. Strictly adhere to guidelines on the implementation of community

quarantine issued by the Inter Agency Task Force on Emerging and
Infectious Diseases and all other authorized bodies regarding mass
gatherings, observance of minimum health standards and physical
distancing.
8. Always fact check and be on alert for any new information or advisory.
9. For any queries, you may contact the following COVID-19 Hotlines:
○ DOH: (02) 894 - COVID (26843) or 1555 (for all subscribers)
○ DOLE: 1349
○ DTI Command Center: 0956 091 6570 (Text/Viber)
○ DILG Emergency Operations Center Hotline: (02) 8876 3454 local 8881 -
8884 to monitor the implementation of COVID-19 response in LGUs
○ One Hospital Command Center: (02) 885-505-00, 0915-777-7777 and
0919-977-3333
SOURCE
https://bwc.dole.gov.ph/
http://www.oshc.dole.gov.ph/images/OSHTrainingAnnouncement/BOSH-
Manual_Narrative-Handout.pdf
https://doh.gov.ph/sites/default/files/publications/workplace-handbook-
on-covid-19-management-and-prevention.pdf
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SELF CHECK 1.2-4
1. How is COVID-19 passed on?

a. Through droplets that come from your mouth and nose when you
cough or breathe out
b. In sexual fluids, including semen, vaginal fluids or anal mucous
c. By drinking unclean water
d. All of the above
2. What are the common symptoms of COVID-19?

a. A new and continuous cough
b. Fever
c. Tiredness
d. All of the above
3. Can you always tell if someone has COVID-19?

a. No – not everyone with COVID-19 has symptoms
b. Yes – it will be obvious, a person with COVID-19 coughs a lot
c. Yes – you can tell just by where a person comes from, their race and
ethnicity
4. Can washing your hands protect you from COVID-19?

a. Yes – but only if you use a strong bleach
b. Yes – normal soap and water or hand sanitizer is enough
c. No – Washing your hands doesn‘t stop COVID-19
5. Which of the following people is COVID-19 more dangerous for? (select all
correct responses)
a. Children
b. Older people – especially those aged 70 and above
c. People with certain underlying health conditions
d. European people
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ANSWER KEY 1.2-4
1. A
2. D
3. A
4. B
5. B&C
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“HAZARDOUS AND INFECTIOUS RISK”
INTRODUCTION
Many workers are at risk of contracting an infectious disease through their

work. The consequences can be very serious. As for any other hazard, as the
health and safety rep you should be involved in the process to identify,
assess and control the risk to workers of infectious diseases in the
workplace.
Action plan for health and safety reps

Like all hazards in the workplace, the process to follow must be that of
identifying whether there is a hazard, assessing the risk, and implementing
controls to eliminate or reduce the list.
Because the risk of contracting an infectious disease may be high at small

exposures, representatives will need to make sure they are effectively
consulted throughout the risk assessment, and the development of
procedures to ensure exposure to infectious diseases is prevented or
controlled.
What Are the Most Common Hazards in a Workplace?
The words ‗risk‘ and ‗hazard‘ are often used interchangeably. However, if
you are responsible for managing the health and safety in your workplace,
it‘s important that you understand the difference between them. The rest of
this article focuses on hazards, including where they might be found in
different workplaces. We also provide you with a range of further resources
to make your risk assessment process as smooth as possible.
The six main categories of hazards are:
1. Biological. Biological hazards include viruses, bacteria, insects,

animals, etc., that can cause adverse health impacts. For example,
mould, blood and other bodily fluids, harmful plants, sewage, dust
and vermin.
2. Chemical. Chemical hazards are hazardous substances that can
cause harm. These hazards can result in both health and physical
impacts, such as skin irritation, respiratory system irritation,
blindness, corrosion and explosions.
3. Physical. Physical hazards are environmental factors that can harm
an employee without necessarily touching them, including heights,
noise, radiation and pressure.
4. Safety. These are hazards that create unsafe working conditions. For
example, exposed wires or a damaged carpet might result in a tripping
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hazard. These are sometimes included under the category of physical

hazards.
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COMMON COMPETENCY
5. Ergonomic. Ergonomic hazards are a result of physical factors that
can result in musculoskeletal injuries. For example, a poor
workstation setup in an office, poor posture and manual handling.
6. Psychosocial. Psychosocial hazards include those that can have an
adverse effect on an employee‘s mental health or wellbeing. For
example, sexual harassment, victimisation, stress and workplace
violence.
Classes of hazard
Every hazardous material is assigned to one of nine hazard classes as

defined in 49 CFR 172.101 and 173. The nine hazard classes are as follows:
Class 1: Explosives.
Class 2: Gases.
Class 3: Flammable and Combustible Liquids.
Class 4: Flammable Solids.
Class 5: Oxidizing Substances, Organic Peroxides.
Class 6: Toxic Substances and Infectious Substances.
Class 7: Radioactive Materials.
Class 8: Corrosives.
Class 9: Miscellaneous Hazardous Materials.
Adapt best practices in the workplace
A safety and health system for your business

As an employer, it is your responsibility to maintain a safe and healthy
workplace. A safety and health management system, or safety program, can
help you focus your efforts at improving your work environment. Whatever
you call it, your plan describes what the people in your organization do to
prevent injuries and illnesses at your workplace.
Your organization will have its own unique system, reflecting your way of
doing business, the hazards of your work, and how you manage the safety
and health of your employees:
 If you manage a small business in a low-risk industry, your system

may simply involve listening to your employees' concerns and
responding to them.
 A large business in a hazardous industry may have notebooks full of
written policies and procedures and a full-time safety director.
What's most important is that your system works for your organization. It's
up to you to decide how best to operate a safe and healthy workplace, and to
put your plan into practice.
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What makes a successful system?
A successful system will be part of your overall business operation, as
important as the other things you do to succeed in business.
Successful safety and health systems have the following in place:

 Managers committed to making the program work.
 Employees involved in the program.
 A system to identify and control hazards.
 Compliance with OSHA regulations.
 Training on safe work practices.
 Mutual respect, caring and open communication in a climate
conducive to safety.
 Continuous improvement
Take a look at your safety and health system. Some components may be
strong and others may need to be strengthened. The following sections
describe these key factors and give ideas about how to make them part of
your program. And remember, if you operate one of many thousands of
small businesses in Maine, your system can be simple and largely informal.
Use the following as a practical guide and adapt it to your needs. Because
small businesses often cannot afford in-house safety and health
professionals, you may need help setting up your system. You can call
SafetyWorks! --- our services are free and confidential. Your workers'
compensation insurance provider, your industry organization, or a private
consultant may also be able to help.
I. Make a commitment
Put as much energy into your commitment to safety and health as you put
into any other important part of your business. Make sure to include
workplace safety and health in your business plan and integrate it into all
facets of the business.
 Write a policy that emphasizes the importance you place on workplace

safety and health.
 Commit the resources (time, money, personnel) needed to protect your
employees.
 Begin meetings with a safety topic.
 Encourage employee participation in safety and health.
 Let employees know they will be expected to follow safe work practices
if they work for your business. And follow them yourself.
 Respond to all reports of unsafe or unhealthy conditions or work
practices.
 If injuries or illnesses occur, make it your business to find out why.
 Go beyond the regulations; address all hazards, whether or not they
are covered by laws.
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Involve employees
In a safe and healthy workplace, employees have a stake in the success of
the program --- safety and health is everyone's responsibility. Actively
encourage employee involvement if you want your program to succeed. Hold
people accountable and makes sure everyone does their part.
 Establish an active workplace safety and health safety committee.

 Make daily safety inspections part of some employees' jobs.
 Keep employees informed about safety inspections, injury and illness
statistics, and other safety-related issues.
 Give everyone a meaningful activity that supports safety.
 Value employee input and feedback. Employees often know more
about safety problems and solutions than managers do.
 Make sure employees help review and improve the program.
 Hold employees accountable
o Include safety and health responsibilities in job descriptions.
Make following safe work practices part of performance
evaluation.
o Set safety goals and hold everyone accountable.
o Discipline employees who behave in ways that could harm
themselves or other.
o Establish a clear system for reporting hazards, injuries,
illnesses and close calls.
o Recognize employees who contribute to keeping the workplace
safe and healthy.
"… we’ve had the employees involved with safety. They are aware of what’s going on and at this
plant there is a culture of people who constantly are looking out for each other and if they see
that someone is doing something unsafe or risky, they are going to say something to them.
They are not afraid to go directly to that person and say, you should have your hair tied back,
or your safety glasses on, or you shouldn’t really be reaching into there."
Ken David, Pride Manufacturing
Identify and control hazards

Before you can control hazards you need to know what the hazards are.
Here are some ways to identify safety and health hazards:
 Review records of accidents, injuries, illnesses, and close calls

 review OSHA logs, first aid logs, workers' compensation reports,
complaints, and close calls
 look for trends or common factors in
o kinds of injuries or illnesses
o parts of body
o time of day/shift
o location
o equipment
o protective equipment
o department
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 Survey employees
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 Review inspection reports from enforcement inspections, insurance
surveys, or consultations.
 Learn the OSHA regulations that have to do with your workplace.
 Inspect your workplace for safety and health problems, current and
potential. SafetyWorks! consultants can help you survey your
workplace.
o Use checklists to locate dangerous conditions.
o Watch employees work to spot unsafe work practices.
o Perform Job Hazard Analysis.
o Conduct air and noise sampling where exposures exist.
Once you know the hazards, you can decide how to control them.
 Prioritize the hazards you found

o Which are most likely to cause serious injury or illness?
o Which can you fix immediately?
o Do you have to make long term plans to correct some of the
hazards?
 Make a plan for correcting the hazards
o Conduct job hazard analysis to identify how best to correct the
hazards
o Find out best practices from companies in your industry
 Correct the hazards
o Engineering controls eliminate the hazards through safe tools,
facilities, and equipment. These are the best controls.
o Administrative controls don't remove the hazards; they reduce
exposure by changing the work practices. For instance, rotating
workers, rest breaks, training programs.
o Personal protective equipment puts a barrier between the
employee and the hazard, using, for example, gloves or safety
shoes. If you use personal protective equipment, you have to
assess the hazard beforehand and train employees the right way
to use the equipment.
 Evaluate the changes to make sure they have corrected the problem
and not created other hazards. And periodically re-survey the work
environment and work practices.
SOURCE
https://www.safetyworksmaine.gov/safe_workplace/safety_management/
https://pe.usps.com/text/pub52/pub52c3_010.htm
https://www.highspeedtraining.co.uk/hub/hazards-in-the-workplace/
https://www.dole.gov.ph
https://www.ohsrep.org.au/general_information_on_infectious_diseases
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SELF CHECK 1.2-5
1. Are environmental factors that can harm an employee without necessarily

touching them, including heights, noise, radiation and pressure.
a. Chemical
b. Safety
c. Physical
d. Biological
2. These are hazards that create unsafe working conditions.

a. Chemical
b. Safety
c. Physical
d. Biological
3. A result of physical factors that can result in musculoskeletal injuries.

a. Chemical
b. Safety
c. Ergonomic
d. Biological
4. Hazardous substances that can cause harm.

a. Chemical
b. Safety
c. Ergonomic
d. Biological
5. Include viruses, bacteria, insects, animals, etc., that can cause adverse
health impacts.
a. Chemical
b. Safety
c. Ergonomic
d. Biological
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ANSWER KEY 1.2-5
1. C
2. B
3. C
4. A
5. D
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“INFECTION CONTROL STANDARD”
INTRODUCTION
Standard Precautions are the minimum infection prevention practices that

apply to all patient care, regardless of suspected or confirmed infection
status of the patient, in any setting where health care is delivered. These
practices are designed to both protect DHCP and prevent DHCP from
spreading infections among patients. Standard Precautions include —
1. Hand hygiene.
2. Use of personal protective equipment (e.g., gloves, masks, eyewear).
3. Respiratory hygiene / cough etiquette.
4. Sharps safety (engineering and work practice controls).
5. Safe injection practices (i.e., aseptic technique for parenteral
medications).
6. Sterile instruments and devices.
7. Clean and disinfected environmental surfaces.
Each element of Standard Precautions is described in the following sections.

Education and training are critical elements of Standard Precautions,
because they help DHCP make appropriate decisions and comply with
recommended practices.
When Standard Precautions alone cannot prevent transmission, they are

supplemented with Transmission-Based Precautions. This second tier of
infection prevention is used when patients have diseases that can spread
through contact, droplet or airborne routes (e.g., skin contact, sneezing,
coughing) and are always used in addition to Standard Precautions. Dental
settings are not typically designed to carry out all of the Transmission-Based
Precautions (e.g., Airborne Precautions for patients with suspected
tuberculosis, measles, or chickenpox) that are recommended for hospital
and other ambulatory care settings. Patients, however, do not usually seek
routine dental outpatient care when acutely ill with diseases requiring
Transmission-Based Precautions. Nonetheless, DHCP should develop and
carry out systems for early detection and management of potentially
infectious patients at initial points of entry to the dental setting. To the
extent possible, this includes rescheduling non-urgent dental care until the
patient is no longer infectious or referral to a dental setting with appropriate
infection prevention precautions when urgent dental treatment is needed.
Hand Hygiene
Hand hygiene is the most important measure to prevent the spread of

infections among patients and DHCP. Education and training programs
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should thoroughly address indications and techniques for hand hygiene

practices before performing routine and oral surgical procedures.
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For routine dental examinations and nonsurgical procedures, use water and
plain soap (hand washing) or antimicrobial soap (hand antisepsis) specific
for health care settings or use an alcohol-based hand rub. Although alcohol-
based hand rubs are effective for hand hygiene in health care settings, soap
and water should be used when hands are visibly soiled (e.g., dirt, blood,
body fluids). For surgical procedures, perform a surgical hand scrub before
putting on sterile surgeon‘s gloves. For all types of hand hygiene products,
follow the product manufacturer‘s label for instructions.
Personal Protective Equipment

Personal protective equipment (PPE) refers to wearable equipment that is
designed to protect DHCP from exposure to or contact with infectious
agents. PPE that is appropriate for various types of patient interactions and
effectively covers personal clothing and skin likely to be soiled with blood,
saliva, or other potentially infectious materials (OPIM) should be available.
These include gloves, face masks, protective eye wear, face shields, and
protective clothing (e.g., reusable or disposable gown, jacket, laboratory
coat). Examples of appropriate use of PPE for adherence to Standard
Precautions include—
 Use of gloves in situations involving possible contact with blood or

body fluids, mucous membranes, non-intact skin (e.g., exposed skin
that is chapped, abraded, or with dermatitis) or OPIM.
 Use of protective clothing to protect skin and clothing during
procedures or activities where contact with blood or body fluids is
anticipated.
 Use of mouth, nose, and eye protection during procedures that are
likely to generate splashes or sprays of blood or other body fluids.
DHCP should be trained to select and put on appropriate PPE and remove
PPE so that the chance for skin or clothing contamination is reduced. Hand
hygiene is always the final step after removing and disposing of PPE.
Training should also stress preventing further spread of contamination while
wearing PPE by:
 Keeping hands away from face.

 Limiting surfaces touched.
 Removing PPE when leaving work areas.
 Performing hand hygiene.
Respiratory Hygiene/Cough Etiquette

Respiratory hygiene/cough etiquette infection prevention measures are
designed to limit the transmission of respiratory pathogens spread by
droplet or airborne routes. The strategies target primarily patients and
individuals accompanying patients to the dental setting who might have
undiagnosed transmissible respiratory infections, but also apply to anyone
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(including DHCP) with signs of illness including cough, congestion, runny

nose, or increased production of respiratory secretions.
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Key Recommendations
1. Implement measures to contain respiratory secretions in patients and

accompanying individuals who have signs and symptoms of a respiratory
infection, beginning at point of entry to the facility and continuing
throughout the visit.
a. Post signs at entrances with instructions to patients with symptoms of

respiratory infection to—
i. Cover their mouths/noses when coughing or sneezing.
ii. Use and dispose of tissues.
iii. Perform hand hygiene after hands have been in contact with
respiratory secretions.
b. Provide tissues and no-touch receptacles for disposal of tissues.

c. Provide resources for performing hand hygiene in or near waiting areas.
d. Offer masks to coughing patients and other symptomatic persons when
they enter the dental setting.
e. Provide space and encourage persons with symptoms of respiratory
infections to sit as far away from others as possible. If available, facilities
may wish to place these patients in a separate area while waiting for care.
2. Educate DHCP on the importance of infection prevention measures to

contain respiratory secretions to prevent the spread of respiratory pathogens
when examining and caring for patients with signs and symptoms of a
respiratory infection.
Sharps Safety
Most percutaneous injuries (e.g., needlestick, cut with a sharp object)
among DHCP involve burs, needles, and other sharp instruments.
Implementation of the OSHA Bloodborne Pathogens Standard has helped to
protect DHCP from blood exposure and sharps injuries. However, sharps
injuries continue to occur and pose the risk of bloodborne pathogen
transmission to DHCP and patients. Most exposures in dentistry are
preventable; therefore, each dental practice should have policies and
procedures available addressing sharps safety. DHCP should be aware of the
risk of injury whenever sharps are exposed. When using or working around
sharp devices, DHCP should take precautions while using sharps, during
cleanup, and during disposal.
Safe Injection Practices

Safe injection practices are intended to prevent transmission of infectious
diseases between one patient and another, or between a patient and DHCP
during preparation and administration of parenteral (e.g., intravenous or
intramuscular injection) medications. Safe injection practices are a set of
measures DHCP should follow to perform injections in the safest possible
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manner for the protection of patients. DHCP most frequently handle

parenteral medications when administering local anesthesia, during which
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needles and cartridges containing local anesthetics are used for one patient
only and the dental cartridge syringe is cleaned and heat sterilized between
patients. Other safe practices described here primarily apply to use of
parenteral medications combined with fluid infusion systems, such as for
patients undergoing conscious sedation. Unsafe practices that have led to
patient harm include
1) use of a single syringe — with or without the same needle — to

administer medication to multiple patients,
2) reinsertion of a used syringe — with or without the same needle — into
a medication vial or solution container (e.g., saline bag) to obtain additional
medication for a single patient and then using that vial or solution container
for subsequent patients, and
3) preparation of medications in close proximity to contaminated supplies
or equipment.
Sterilization and Disinfection of Patient-Care Items and

Devices
Instrument processing requires multiple steps using specialized equipment.
Each dental practice should have policies and procedures in place for
containing, transporting, and handling instruments and equipment that
may be contaminated with blood or body fluids. Manufacturer‘s instructions
for reprocessing reusable dental instruments and equipment should be
readily available—ideally in or near the reprocessing area. Most single-use
devices are labeled by the manufacturer for only a single use and do not
have reprocessing instructions. Use single-use devices for one patient only
and dispose of appropriately.
Environmental Infection Prevention and Control

Policies and procedures for routine cleaning and disinfection of
environmental surfaces should be included as part of the infection
prevention plan. Cleaning removes large numbers of microorganisms from
surfaces and should always precede disinfection. Disinfection is generally a
less lethal process of microbial inactivation (compared with sterilization) that
eliminates virtually all recognized pathogenic microorganisms but not
necessarily all microbial forms (e.g., bacterial spores).
SOURCE
https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-
prevention-practices/standard-precautions.html
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SELF CHECK 1.3-1
1. What is required before you perform hand hygiene? Select all that apply
a. Remove bracelets.
b. Fingernails should be short.
c. Assess hands for visible soil.
d. Rings should not have jewels or stones
2. Place the following Hand Hygiene techniques in the correct order:

a. Check the visible soil on hands
b. Wet hands
c. Dry hands
d. Apply soap
e. Scrub hands
3. What is the appropriate flow and water temperature when washing your
hands?
a. A medium flow and warm water.
b. A medium flow and hot water.
c. A slow flow and warm water.
d. A fast flow and cool water
4. Your hands and forearms should be lower than your elbows when
performing hand hygiene routine.
a. True
b. False
5. What should you do if your hands touch the sink while you are washing
your hands?
a. Continue to wash your hands.
b. Repeat the procedure.
c. Apply more friction during procedure.
d. Add more soap to your hands
6. It is important to remove all the soap from your wrists and hands;
keeping your hands up and your elbows down to rinse away the
microorganisms.
a. True
b. False
7. How should you dry your hands?

a. In a circular motion covering all areas of the hands and wrists.
b. Wrists to finger tips in one direction.
c. Lightly pat and allow hands to air dry.
d. Dry your hands thoroughly
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ANSWER KEY 1.3-1
1. A–B–C
2. A –B – D – E – C
3. A
4. A
5. B
6. B
7. D
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HCS323202
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“PLANNED RESPONSES”
INTRODUCTION
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An infectious disease is transmitted either by inhalation of infectious
particles/droplets or direct contact of the particles/droplets with mucous
membranes in the respiratory tract or eyes. Infectious diseases may include
the Novel Coronavirus (COVID-19), MERS, SARS, Ebola, Anthrax, pandemic
flu, and other known diseases. Examples of infectious diseases for which
this plan could apply are included in Appendix A -Descriptions of infectious
diseases.
Coronavirus Disease (COVID-19)

The information for infection with SARS-CoV-2 (COVID-19) has been
updated as of April 2020.
Coronavirus Disease 2019 (COVID-19) is a respiratory disease caused by the

SARS-CoV-2 virus. It has spread from China to many other countries
around the world, including the United States. To reduce the impact of the
COVID-19 outbreak, our company has developed a preparedness and
response plan.
Symptoms of COVID-19
Infection with SARS-CoV-2, the virus that causes COVID-19, can cause
illness ranging from mild to severe and, in some cases, can be fatal.
Symptoms typically include fever, cough, and shortness of breath. Some
people infected with the virus have reported experiencing other non-
respiratory symptoms. Other people, referred to as asymptomatic cases,
have experienced no symptoms at all.
According to the CDC, symptoms of COVID-19 may appear in as few as 2

days or as long as 14 days after exposure.
How COVID-19 spreads

COVID-19 started from exposure to an infected animal. Infected people can
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spread COVID-19 to other people. The virus is thought to spread mainly

from person-to-person, including:
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 Between people who are in close contact with one another (within
about 6 feet).
 Through respiratory droplets produced when an infected person
coughs or sneezes. These droplets can land in the mouths or noses of
people who are nearby or possibly be inhaled into the lungs.
 It may be possible that a person can get COVID-19 by touching a
surface or object that has the virus on it and then touching their own
mouth, nose, or possibly their eyes, but this is not thought to be the
primary way the virus spreads.
 People are thought to be most contagious when they are most
symptomatic (i.e., experiencing fever, cough, and/or shortness of
breath). Some spread might be possible before people show symptoms;
there have been reports of this type of asymptomatic transmission
with this new coronavirus, but this is also not thought to be the main
way the virus spreads
How COVID-19 can affect our workplace

We may see increased absenteeism from workers:
 Who are sick
 Caring for a sick family member
 Caring for children if schools or day care centers are closed
 Have at-risk people at home
We may need to change the way we do business and continue operations,

including the following:
 Reducing person to person contact
o Considering alternative ways to work (e.g. telework, stagger
shifts, reduced number of workers on site at one time)
o Find alternative ways to work with or help our customers
 Cross-training our staff to cover essential functions and operations
We may see interrupted supply/delivery:

 Shipments from affected areas may be delayed or cancelled
Occupational Exposure to COVID-19

Occupational exposure to infectious diseases is work activity or work
conditions that are reasonably anticipated to present an elevated risk of
contracting these diseases without protective measures in place. Where
appropriate, our company will follow the recommendations of federal, state,
and local health authorities to address considerations related to
occupational exposure to infectious diseases including, but not limited to
the following:
 Where, how, and to what sources of infection workers might be
exposed including:
o The general public, customers, and coworkers; and
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o Sick individuals or those at particularly high risk of infections

(e.g., international travelers who have visited locations with
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COMMON COMPETENCY
healthcare workers who have had unprotected exposures to
people known to or are suspected of being infected)
 Worker‘s individual risk factors (older age; medical conditions;
pregnancy)
 Controls necessary to address those risks
OSHA has provided guidance on classifying worker exposure to COVID-19

into four categories: very high, high, medium, and lower (caution) risk.
Worker exposure classification depends in part on the industry type, need
for contact within 6 feet of people known to be, or suspected of being,
infected with COVID-19.
Worker Exposure Classifications for COVID-19
Very High Exposure Risk: This category includes jobs with a high potential
for exposure to known or suspected sources of COVID-19 during specific
medical, postmortem, or laboratory procedures. Workers in this category
include:
 Healthcare workers performing aerosol-generating procedures (e.g.,
intubation, cough induction procedures, bronchoscopies, some dental
procedures, and exams, or invasive specimen collection) known or
suspected COVID-19 patients
 Healthcare or laboratory personnel collecting or handling specimens
from known or suspected COVID-19 patients
 Morgue workers who are performing autopsies, which generally
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involve aerosol-generating procedures, on the bodies of people who are

known to have, or suspected of having, COVID-19 at the time of their
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High Exposure Risk: This category includes jobs with a high potential for
exposure to known or suspected sources of infectious disease Workers in
this category include:
 Healthcare delivery and support staff exposed to known or suspected
infectious patients
 Medical transport workers (e.g., ambulance vehicle operators) moving
known or suspected infectious patients in enclosed vehicles.
 Mortuary workers involved in preparing (e.g., for burial or cremation)
the bodies of people who are known to have, or suspected of having,
infection at the time of their death.
Medium Exposure Risk: This category of jobs includes those that require
frequent and/or close contact with (i.e., within six feet of) other people who
may be infected with the virus that causes COVID-19 but are not known or
suspected COVID-19 patients.
Lower Exposure Risk (Caution): This category covers jobs that do not
require contact with people known to be, or suspected of being, infected with
the virus that causes COVID-19 nor require frequent close contact with (i.e.,
within six feet of) the general public.
Ways to Mitigate Risk of Exposure to COVID-19
Basic infection prevention measures

We are asking every one of our employees to help with our prevention efforts
while at work. In order to minimize the spread of COVID-19, we all must
play our part. As set forth below, our company has instituted various
housekeeping, social distancing, and other best practices. All employees
must follow these. In addition, employees are expected to report to their
managers or supervisors if they are experiencing signs or symptoms of
COVID-19, as described below. If you have a specific question about this
Plan or COVID-19, please ask your manager or supervisor. If they cannot
answer the question, please contact the local public health authority.
Basic infection prevention measures will be emphasized to protect workers

during an infectious disease outbreak. Where appropriate, our company will
follow the recommendations of federal, state, and local health authorities.
OSHA and the CDC have provided the following control and preventative
guidance to all workers, regardless of exposure risk:
 Frequently wash your hands with soap and water for at least 20
seconds. When soap and running water are unavailable, use an
alcohol-based hand rub with at least 60% alcohol.
 Avoid touching your eyes, nose, or mouth with unwashed hands.
 Follow appropriate respiratory etiquette, which includes covering for
coughs and sneezes.
 Avoid close contact with people who are sick.
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 Use tissues for sneezes and dispose of them in the trash receptacle.
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COMMON COMPETENCY
 Do not share work tools and equipment.
In addition, employees must familiarize themselves with the symptoms of

COVID-19:
 Coughing;
 Fever;
 Shortness of breath, difficulty breathing; and
 Early symptoms such as chills, body aches, sore throat, headache,
diarrhea, nausea/vomiting, and runny nose.
If you develop a fever and symptoms of respiratory illness, such as cough or

shortness of breath, you will be asked to stay home and to call your
healthcare provider right away. Likewise, if you come into close contact with
someone showing these symptoms, call your healthcare provider right away.
Worker Protection
We shall use feasible engineering controls and work practice controls to

reduce employee exposure to infectious diseases. When those controls are
not sufficient, we shall provide personal protective equipment. We have
defined appropriate workplace controls for our various worker exposure risk
classifications using Appendix C – Infectious disease workplace controls
checklist.
Refer to our PPE and Respiratory Protection Programs for specific

requirements where PPE and/or respirators are included as appropriate
workplace controls for infectious disease hazards. Workplace flexibilities and
protections will be emphasized to protect workers during an infectious
disease outbreak. Where appropriate, and as identified in Appendix C, our
company will follow the recommendations of federal, state, and local health
authorities which may include, but not be limited to the following:
 Have sick employees stay home
 Ensure that sick leave policies are flexible and consistent with public
health guidance and that employees are aware of these policies
o Talk with companies that provide our business with contract or
temporary employees about the importance of sick employees
staying home and encourage them to develop non-punitive leave
policies
o Maintain flexible policies that permit employees to stay home to
care for a sick family member
o Recognize that workers with ill family members may need to
stay home to care for them
 Establish policies and practices to increase the physical distance
among employee and between employees and others if health
authorities recommend use of social distancing
o Implementing flexible worksites (e.g., telework)
o Implementing flexible work hours (e.g., staggered shifts)
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o Increasing physical space between employees at the worksite

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o Increasing physical space between employees and customers
(e.g., drive through, partitions)
o Implementing flexible meeting and travel options (e.g., postpone
non-essential meetings or events)
 Delivering services remotely (e.g. phone, video, or web)
 Delivering products through curbside pick-up or delivery
Finally, we will also be maintaining regular housekeeping practices,

including cleaning and disinfection of the work environment. See Appendix
D for COVID-19 Prevention with enhanced cleaning and disinfection.
Methods to Respond if Exposure Incidents Occur
Employee Exhibiting COVID-19 Symptoms

If an employee exhibits COVID-19 symptoms, the employee will be asked to
call their healthcare provider and to return home. The employee may return
to work consistent with CDC and state and local guidelines.
Employee Tests Positive for COVID-19

An employee that tests positive for COVID-19 will be directed to self-
quarantine away from work. The employee may return to work consistent
with CDC and state and local guidelines.
If our company learns that an employee has tested positive, our company
will conduct an investigation into co-workers that may have had close
contact with the confirmed-positive employee in the prior 14 days and direct
those individuals that have had close contact with the confirmed-positive
employee to call their healthcare provider regarding the length of time to
stay home. Close contact is defined as six (6) feet for a prolonged period of
time.
The employee may return to work consistent with CDC and state and local
guidelines.
Employee Has Close Contact with a Tested Positive COVID-19

Individual
If an employee learns that he or she has come into close contact with a
confirmed-positive individual outside of the workplace, he/she must alert a
manager or supervisor of the close contact and also call their healthcare
provider regarding the length of time to stay home. The employee may return
to work consistent with CDC and state and local guidelines
Note: These guidelines may change as CDC and state and local guidelines
develop.
Communication
Infectious disease outbreaks can evolve rapidly. Our company will
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communicate to our workers as information becomes available on the

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following topics according to the guidelines defined in Appendix E – Crisis
communications plan.
 Information about the infectious disease outbreak
 Changes to our business operations including workplace policies,
workplace protections, and flexibilities
 Notifying workers if a person in the facility has been confirmed
infectious or has been around someone who has been confirmed
infectious for their potential exposure.
Training
The following training is provided to our employees who have occupational
exposure to infectious disease:
 Explanation of infectious disease
 Modes of transmission and applicable control procedures
 Review of recognized tasks and activities that may pose an exposure
 Appropriate workplace controls, which may include engineering and
administrative controls, safe work practices, and PPE
 Selection of PPE as appropriate, proper use, location, removal,
handling, cleaning, decontamination and disposal of items
Training materials may include but are not limited to the following:
 Appendix G – COVID-19 Toolbox talk
 Appendix H –Sequence for putting on personal protective equipment
(CDC)
 Appendix I – How to properly put on and take off a disposable
respirator (CDC)
SOURCE
https://www.simcoemuskokahealth.org/docs/default-source/topic-
emergencyprep/infectious-disease-emergency-response-
plan_public.pdf?sfvrsn=0
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SELF CHECK 2.1-1
1. Why is it important for you to perform hand hygiene prior to leaving an

isolated area?
a. To reduce the risk of contaminating visitors and other clients
b. To reduce the risk of contaminating yourself
c. To reduce the risk of contaminating the surrounding environment
d. To reduce the risk of contaminating fellow health care professionals
2. How do you correctly put on the gloves when donning PPE?

a. Gloves fit over cuff of gown.
b. Gloves fit under cuff of gown.
3. If you wear gloves while providing care, hand hygiene is not required.
a. True
b. False
4) Your infection control department tells you that a patient can be managed
using routine practices. This means:
a. The patient does not have any bacteria and does not pose a risk to
staff or other patients
b. Any care being provided is routine in nature and presents no risk of
infection
c. A risk assessment should be done before providing care and PPE worn
as appropriate to the situation and the care being provided
5. You are working on a Friday night and several patients become

symptomatic with vomiting and diarrhea. You should:
a. Wait till Monday morning and then contact infection control
b. No action is required; the day shift will sort it out
c. Place the patients on contact precautions, chart symptoms and follow
your facility‘s procedure for reporting a suspected outbreak
d. Ignore the situation and pretend you did not notice anything out of
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ANSWER KEY 2.1-1
1. A–B–C–D
2. A
3. B
4. C
5. C
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“DIFFICULT OR CHALLENGING BEHAVIOR”
INTRODUCTION
Some people with a learning disability display ‗behaviour that challenges‘.

Behaviour that challenges is not a diagnosis and is used in this guideline to
indicate that such behaviour is a challenge to services, family members,
careers and the person, but may be functional for the person with a learning
disability. The behaviour may appear only in certain environments, and the
same behaviour may be considered challenging in some settings or cultures
but not in others. It may be used by the person for reasons such as creating
sensory stimulation or gaining assistance. Some care environments increase
the likelihood of behaviour that challenges. This includes those with limited
social interaction and meaningful occupation, lack of choice and sensory
input, excessive noise, those that are crowded, unresponsive or
unpredictable, and those characterized by neglect and abuse.
Identifying difficult behaviors in your workplace
What are difficult behaviors?

Some young people may display aggressive and violent behaviour, especially
if they are experiencing AOD problems as well. This may happen for a
variety of reasons. Difficult behaviors (also referred to as challenging
behaviour) can include:
 Verbal aggression - is similar to bullying except it does not include
physical aggression. It is the use of words or gestures to cause
psychological harm that differentiates verbal aggression from physical
bullying. Many bullies rely on verbal, social, and physical methods of
intimidation and harassment.
 Intimidation or threats - (also called cowing) is intentional behavior
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that "would cause a person of ordinary sensibilities" to fear injury or

harm. Threat, criminal threatening (or threatening behavior) is the
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COMMON COMPETENCY
crime of intentionally or knowingly putting another person in fear of
bodily injury.
 Self-harming behaviour (or threats to do so) - Self-harm or self-
injury means hurting yourself on purpose. One common method is
cutting with a sharp object. But any time someone deliberately hurts
themself is classified as self-harm. Some people feel an impulse to
cause burns, pull out hair or pick at wounds to prevent healing.
Extreme injuries can result in broken bones.
 Physical aggression (to people, animals and property) - is behavior
causing or threatening physical harm towards others. It includes
hitting, kicking, biting, using weapons, and breaking toys or other
possessions.
 Passivity/withdrawal - acceptance of what happens, without active
response or resistance
 Running away - he act of running away out of control also: something
(such as a horse) that is running out of control.
 Aggression/Assaultive behavior - is overt or covert, often harmful,
social interaction with the intention of inflicting damage or other harm
upon another individual. It may occur either reactively or without
provocation.
 Confusion or other cognitive impairment - s a term used to
describe someone's current state. It generally presents as a state of
confusion, loss of memory or attentiveness, trouble understanding or
making sense, difficulty recognizing people, places or things, or
changes to mood.
 Noisiness - the auditory effect characterized by loud and constant
noise
 Manipulative - especially : serving or intended to control or influence
others in an artful and often unfair or selfish way a clever
 Intoxication - the condition of having physical or mental control
markedly diminished by the effects of alcohol or drugs drank to the
point of intoxication cocaine intoxication.
 Depressed - a constant feeling of sadness and loss of interest, which
stops you doing your normal activities.
 Negativistic - behavior characterized by persistent refusal, without
apparent or logical reasons, to act on or carry out suggestions, orders,
or instructions of others.
 Intrusive behavior - typically unwelcome and recipients of intrusive
behavior may feel like the intruder is coming without welcome or
invitation, invading their personal space, or interfering in their private
life. People who are introverted may be more likely to experience the
feeling of being intruded upon.
The key to dealing with these behaviors respectfully understands why they
might be occurring. So, let's consider some of these reasons by reflecting on
the youth-focused systems approach. In the module Perspectives in Working
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with Young People we looked at how different factors impact on young

people. In the same way these factors also influence young people's
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behaviour.

COMMON COMPETENCY
Risk and protective factors include:
Local community factors: population density; housing conditions;

urban/rural area; neighborhood violence and crime; cultural norms, identity
and ethnic pride; opportunities for social development; recreational and
support services; demographic and economic factors; connectedness or
isolation.
School and peer factors: peer connectedness; school climate and culture;
school attendance; opportunities for social connection; norms and values of
peers and school; friendships and interests; educational approach/methods;
school discipline and structure.
Individual characteristics: personality and intelligence; gender; cultural

background; physical and mental health; social skills and self esteem;
sexual behaviour/sexuality; alcohol and drug use; criminal involvement;
living situation/homelessness; values and beliefs.
Family factors: abuse and neglect; family dysfunction; patterns of

communication; family income/employment; parents' mental and physical
health; consistency of connection; family values, beliefs and role models;
family discipline and structure; extended/nuclear family; family size.
Societal and political issues: laws of society; socio-economic climate;

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availability of services; social values and norms; social/cultural practices

and traditions; popular culture (e.g. movies and music); government ideology
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Reasons for difficult behaviours
Individual factors:
 Boredom – to make something happen
 Fear – of other young people; of trusting workers; of themselves. A
young person who has experienced little stability or supportive care
within their family may be scared to trust others
 Frustration – young people may have pent up rage and frustration at
their own or others inadequacies. For example, a young person may
have learning and literacy difficulties that have never been adequately
identified or addressed.
 Immaturity – some young people have not developed skills to
understand or manage their emotions and can resort to childlike ways
of behaving in certain circumstances
 Anger – (often unconscious) about past unresolved issues that
manifests itself in everyday behaviour
 Previous negative experiences – the young person may be reliving
past negative interactions with authority figures (e.g. police, teachers,
and parents) where they experienced hurt, degradation or physical
assault.
 Confusion – about circumstances over which they may feel they have
little control e.g. break-up of their parent's marriage, death of a friend
or their own sexuality.
 Hopelessness – some young people may believe that they have
nothing to lose
 Effects of AOD use, illness, mental illness, etc
 Individual issues such as learning disabilities, intellectual disability,
hyperactivity, mental health issues
Family factors:
 May include abuse and neglect, family discord or unstable
relationships
Peer and school factors:

 These may include school problems such as poor academic
performance, bullying or being bullied, difficulties with peers, lack of
connection, culture of peer group, use of alcohol and other drugs
Community factors:
These may include isolated communities, lack of community resources,
limited opportunities or lack of recreational activities etc.
Societal factors:
 These may include poor housing, unemployment, poverty, societal
discrimination regarding race, class, gender, sexuality etc.
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Our understanding of the tasks and needs characteristic of adolescent
development can help us in our understanding of difficult behavior.
However, we cannot make assumptions about behaviors and we must be

careful to avoid stereotyping young people.
Young people arrive at adolescence at different stages along the

developmental pathway. This pathway has been influenced in various ways
by many people and experiences. The roots of difficult behaviors are complex
and cumulative and they are embedded in the social as well as the personal
histories of the young person. A combination of factors is therefore
associated with difficult behaviour and delinquency.
Understanding difficult behaviors
Task - writing exercise

Think about some of the young people that you have worked with who have
presented with 'difficult' behaviour. Identify those behaviors and reflect on
some of the possible reasons for that behaviour.
Difficult behaviors example: 16-year-old male

 'macho', bullying behaviour (to cover his own fears or 'inadequacies')
 refusal to comply with rules/laws
 ringleader, shows off in front of his peers
 can be verbally aggressive
Possible reasons example: 16-year-old male

 confusion about identity/sexuality
 learning difficulties that have never been addressed
 learned behaviour from other members of the family
 lack of positive attention throughout childhood and adolescence
There can be a multitude of complex and conflicting reasons for a young

person's difficult behaviour and we'll now start to consider how we can
manage such behaviors.
SOURCE
https://www1.health.gov.au/internet/publications/publishing.nsf/Content
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COMMON COMPETENCY
SELF CHECK 2.1-2
1. Setting an example for children through your actions and words is an

example of
a. Modeling
b. Redirecting
c. Guidance
d. Punishment
2. Avoiding acknowledgment of bad behavior is called

a. Redirect
b. Warning
c. Ignoring
d. Modeling
3. Warnings should be provided

a. Twice
b. As often as necessary
c. Never
d. Once
4. Ways to handle challenging behaviors includes all of the following except

a. Ignoring the behavior
b. Embarrassing the person
c. Modeling
d. Redirecting
5. A cause for behavior problems include

a. under-stimulation
b. teacher personality
c. over-planning
d. wait time
6. All behavior is purposeful, even misbehavior.

a. True
b. False
7. Fill in the blank: ________ people as they are. Don't make your acceptance
________ on their behavior.
a. Respect ; hinge
b. Judge ; reflect on
c. Reject ; build
d. Accept ; dependent
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COMMON COMPETENCY
ANSWER KEY 2.1-2
1. A
2. C
3. D
4. B
5. D
6. A
7. D
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“STRATEGIES APPROPRIATE”
INTRODUCTION
Dealing with challenging behavior is one of the most difficult aspects of the
community and sadly the one that causes the most anxiety in the
workplace. This is for good reason. If you fail to keep control of a person and
enable the challenging behaviour from disrupting others to dictate, none of
the other members will be able to learn and you will be unable to control in
the way you were trained for.
Respond to challenging behaviour
Immediate actions if a situation is escalating
If a person is becoming agitated, but their behaviour is not placing them or

others in harm, use the restraint and seclusion de-escalation tactics. These
tactics are useful even if restraint or seclusion is not required.
Follow up with a longer term intervention plan to prevent inappropriate

behaviour in the future.
If persons‘ behaviour is posing a risk to safety, follow incident and

emergency guidelines.
Successful interventions
Successful interventions require:

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 strong staff-client relationships

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 an understanding of the underlying factors influencing behaviour

COMMON COMPETENCY
 an understanding of the immediate triggers for its occurrence.
For example, issuing a detention might be an appropriate response to a

person who is being highly disruptive in a workplace. You should also
identify the reasons and triggers for the behaviour and address these where
possible to reduce future problems.
The type of disciplinary measure used for challenging behavior will depend
on the nature and severity of the incident.
Any decisions made about addressing challenging behaviors should be

clearly documented and discussed with the guardian.
Intervention strategies
Where students repeatedly demonstrate challenging behaviour, schools

should implement more structured intervention strategies as part of a
staged response to address the behaviour. Strategies can include:
 Asses the behaviour, focus on its influences, triggers and function (ie
what purpose it serves). This should involve observation and talking
with the student, their family and relevant wellbeing professionals.
 Develop a behaviour support plan and/or individual education plan.
 Consider if any environmental changes need to be made, for example
changing the classroom set up.
 Explicit teaching of replacement behaviours (recognize students will
need time to practice these before they become habit).
 Engage appropriate support services, such as a student welfare
coordinator, student support services or community agencies to
undertake assessments and/or provide specialist support.
 Establish a student support group to establish the student‘s needs
and supports required.
 Implement appropriate disciplinary measures that are proportionate
to problem behaviours.
 Consider alternative learning or behaviour management options such
as student development centers or re-engagement programs.
 Use the staged response checklist as a guide to consider, implement
and document your responses to incidents of challenging behaviour.
 Some restraint and seclusion prevention strategies may also be useful
(even if actual restraint or seclusion is not needed).
Who responds to challenging behavior?
You spend the most time with the client, therefore support and discipline
responses should always involve the area.
Where there are ongoing behaviour issues, you should work with
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workplaces‘ leadership and/or office wellbeing staff to get specialist support

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COMMON COMPETENCY
is being considered, the area supervisor must be directly involved in
decision-making.
Challenging behaviour training

We offer a managing challenging behaviours training course
The program:
 enhances understanding of the factors influencing behaviour
 builds skills in promoting positive behaviour
 builds skills in responding to challenging behaviour.
Record keeping
Schools should keep detailed records of instances of challenging behaviour
and management responses reported by employer, employees, non-school
based staff and the community.
Records of behaviour incidents should focus on the facts of a situation and

not include vague or unsubstantiated claims or value judgments.
The purpose of good record keeping practice is to:
 allow staff to monitor the behaviour and wellbeing of individual

students
 ensure student behaviour is being responded to in a consistent and
staged manner
 monitor the effectiveness of strategies used
 support principals in their decision-making process concerning
suspensions and expulsions.
SOURCE
https://education.vic.gov.au/school/teachers/behaviour/student-
behaviour/Pages/respondingtobehaviour.aspx
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SELF CHECK 2.1-3
1. Emerson et al (1987) offered which of the following as a definition of

challenging behaviour
a. Any incidents where staff are abused, threatened or assaulted in
circumstances related to their work, involving an explicit or implicit
challenge to their safety, well-being or health.‖
b. Behaviour of such an intensity, frequency or duration that the
physical safety of the person or others is likely to be placed in serious
jeopardy, or behaviour which is likely to seriously limit or delay access
to and use of ordinary community facilities
2. When caring for a service user who has challenging behaviour, what
should the Registered Nurse for people with Learning Disabilities (RNLD)
first look at/review if the behaviours become more intense and/or frequent?
a. The health care needs of the individual
b. The environment the individual is in
c. The relationships the individual has with those around them
d. Any changes/disruptions to the individuals life
e. The medication the individual is on
3. What can be deemed as challenging behaviour?

a. Verbal abuse
b. Biting
c. Sexual Harassment
d. Obsessional behaviours
e. All of the above
4. What is an antecedent?
a. The 'trigger' of a behavior
b. Behaviour that is inappropriate
c. The reaction to the behaviour
5. What is the assumption that behavioral theorists associate with

challenging behaviour?
a. That challenging behaviour is learned and maintained
b. That challenging behaviour is instinctual
c. That challenging behaviour is impulsive
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COMMON COMPETENCY
ANSWER KEY 2.1-3
1. B
2. A
3. E
4. A
5. A
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HCS323203
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COMMON COMPETENCY
“EMERGENCY ACTION PRINCIPLE OF FIRST AID”
INTRODUCTION
First aid involves timely response to emergencies and immediate care of sick
and injured people. Trained first aiders apply a range of procedures and
techniques that offer care when accidents and injuries occur, often making
the difference between life and death during high-risk, low-frequency
emergencies. More than ever, first aid intervention is a valuable link in the
life saving chain, where casualties are addressed and monitored prior to the
arrival of emergency services personnel.
Basic principles of first aid include:

1. Safe response to emergencies for the benefit of casualties, bystanders
and rescuers
2. Securing the emergency site to reduce further harm to the casualty
3. Using appropriate first aid procedures and techniques
4. Safely moving the casualty, minimizing pain and helping stabilize the
condition
5. Providing reassurance and guidance to the casualty
6. Communication with bystanders and emergency services personnel
7. Acting in accord with first aid protocol and workplace guidelines
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What Should Be Included In A First Aid Kit?
Every trained first aider should have access to a first aid kit. Accidents and
injuries are inevitable anywhere people gather, while health and safety
standards are increasingly prioritized in the workplaces, schools and
community settings. First aid kits contain basic elements for dealing with
common injuries, along with accessories to ensure both casualty and first
aider are protected. General first aid kits contain several items, including:
 Gloves
 Dressings
 Antiseptic
 Face Shield for CPR
Industry standard workplace first aid kits contain additional items for a
tailored response, such as those required to treat burns victims. First aid
equipment and devices should be stored and maintained appropriately, and
can be expanded upon as part of a dedicated first aid room for addressing
wide-ranging injuries. Real Response courses include options for on-site
training, localized risk and hazard minimization, employee education and
the establishment of a first aid room.
Principles of First Aid
Preserve Life
The first aim of first aid is to preserve life, which involves the key emergency
practices to ensure that the casualty isn‘t in any mortal danger. Remember
though, this includes preserving your own life as you shouldn‘t put yourself
in danger in order to apply first aid. It‘s at this stage where you should do a
quick risk assessment to check for dangers to the injured person, yourself
or bystanders which could cause the situation to escalate. If in doubt, do
not attempt to apply first aid and immediately call for a medical
professional.
Prevent Deterioration
Once you‘ve followed all the steps associated with the first principle, your
next priority is to prevent deterioration of the injured person‘s condition.
Keeping a casualty still to avoid aggravating their injury, or from
complicating any unseen issues, is crucial. This helps prevent to further
injuries, and clearing the area of any immediate dangers will help you to do
so.
Promote Recovery
Finally, there are steps you should follow which will help lessen the amount
of time taken for a casualty to recover from an accident and aid in
minimizing lasting damage and scarring. The prime example of this is
applying cold water to a burn as soon as possible to lower the chance of
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COMMON COMPETENCY
First Aid Practices
Taking immediate action

This is the key to the ‗Preserving Life‘ principle – a quick response to an
accident can save lives and minimise the risk that things get worse. If
someone needs help, either from an injury or sickness, you shouldn‘t
hesitate to help if possible.
Calming down the situation

First aiders should be able to remain calm under pressure and help reduce
the overall stress levels of the injured person as well as other people who
may be concerned. Reassurance can provide more support that you might
expect in an emergency situation and help people make the right decisions.
Calling for medical assistance

Make sure to get a hold of the emergency services by calling 999 as soon as
possible, either by calling directly yourself or asking a bystander to do so if
you‘re preoccupied handing the injury. This will ensure that a medical
professional arrives quickly to handle the situation in a more comprehensive
manner and provide more specialist treatment.
Apply the relevant treatment

Before a medical professional does arrive, you will need to apply first aid
treatments in order to stabilized the condition of the injured person. This
comes under the ‗preserve life‘ banner, and follows this flow of procedures:
 Check for consciousness

 Open the airway
 Check for breathing Follow airway, breathing, of resuscitation,
administer CPR if needed
 Check for circulation
 Check for bleeding, controlling any major bleeding
There are a number treatments which correspond to the different problems

that might arise as you work through this list, e.g. CPR, applying a
tourniquet, running a burn under cold water, etc.
First Aid Legislation

Under the Republic Act No. 10871, July 17, 2016, employers are responsible
for making sure that their workplace has a health and safety policy. This
should include arrangements for first aid.
This places a responsibility on all employers (no matter the size of their
business) to provide adequate resources to those who are injured at work.
This includes ensuring there is equipment, facilities and first aiders who
have had appropriate training.
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If you‘re interested in finding out more about first aid and the different
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treatments which can be needed in an emergency situation, take a look at

COMMON COMPETENCY
our online first aid course which covers everything you need to know about
first aid including what you‘ll need in a first aid kit.
The role and responsibilities of an emergency first aider
An emergency first aider has various roles and responsibilities. It is

important first aiders take these roles and responsibilities seriously as first
aid is potentially lifesaving in an emergency situation.
The role of a first aider is to provide immediate, lifesaving, medical care

before the arrival of further medical help. This could include performing
procedures such as:
 Placing an unconscious casualty into the recovery position

 Performing Cardiopulmonary Resuscitation (CPR)
 Using an automated external defibrillator (AED)
 Stopping bleeding using pressure and elevation
 Keeping a fractured limb still
A first aider‘s overall aim should be to preserve life. Other aims of first aid
include prevent the worsening of the patient‘s condition and to promote
recovery.
A first aider has various responsibilities when dealing with an emergency

situation. A first aider should:
 Manage the incident and ensure the continuing safety of themselves,
bystanders and the casualty
 Assess casualties and find out the nature & cause of their injuries
 Arrange for further medical help or other emergency services to attend
(e.g: the fire service)
 If trained, prioritize casualties based upon medical need
 Provide appropriate first aid treatment as trained
 If able, make notes/observations of casualties
 Fill out any paperwork as required
 Provide a handover when further medical help arrives
SOURCE
https://laws.chanrobles.com/republicacts/109_republicacts.php?id=10656
https://www.virtual-college.co.uk/resources/2019/08/the-principles-and-
practices-of-first-aid
https://www.firstaidforfree.com/the-role-and-responsibilities-of-an-
emergency-first-aider
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SELF CHECK 3.1-1
1. A first aid responder should move a victim when….

a. it would make it easier to administer first aid.
b. The victim is in a dangerous position.
c. Never
d. Both a & b
2. There are three basic steps you can take in an emergency:

a. Call, Check, Care
b. Check, Call, Care
c. Recognize, Decide, Call
d. Decide, Execute, Call
3. You approach a victim that is unconscious and wearing a medical alert

tag indicating a diabetic condition. You would:
a. Begin Rescue Breathing
b. Begin CPR
c. Administer the victim‘s insulin
d. Check victim for breathing & pulse
4. An eight year old child is unconscious and the airway is blocked. You
should:
a. Give abdominal thrusts
b. Begin CPR
c. Begin Rescue Breathing
d. All of the above
5. A victim is coughing up blood with bleeding from the mouth and is tender
in the abdomen. Pulse is weak and rapid. The victim is having signs of
a. Massive head injuries
b. Internal Bleeding
c. Drug Overdose
d. Possible Poisoning
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COMMON COMPETENCY
ANSWER KEY 3.1-1
1. D
2. B
3. D
4. A
5. B
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“PHYSICAL HAZARD”
INTRODUCTION
Physical hazards are factors or conditions within the environment that can
harm your health.
Types of physical hazards
The main factors and conditions associated with physical hazards include:
 body stressing
 confined spaces
 electricity
 heat
 heights
 noise
 vibration
Body Stressing
Body stressing is a collective term covering a broad range of health problems

associated with repetitive and strenuous work.
Factors influencing body stressing

Body stressing injuries, or musculoskeletal disorders (MSD), often develop
from carrying out hazardous manual tasks.
Body stressing injuries at work can result from a variety of factors:
 Psychosocial aspects of work – factors such as job demands,

control, support and satisfaction, imbalance between effort and
reward and monotony of tasks. Financial concerns or relationship
issues may also contribute.
 Biomechanical - soft tissue damage which may occur through:
 direct exposure (blunt trauma or sudden overload), leading to a
muscle tear or sprain, or
 indirect exposure (repeated light loading), leading to symptoms
that may accumulate to cause further degeneration and injury.
 Individual worker characteristics – factors including health
problems or out of hours demands.
Body stressing sources of risk

Manual handling and computer usage are key risks for body stressing.
Using a Risk Management Approach can help assess the likelihood of a

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hazard progressing to a risk.

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The Body Stressing Sources of Risk checklist is designed to help managers,
workplace health staff and rehabilitation providers identify and address
body stressing injury risks including:
 work area design and layout
 systems of work and work organization
 loads, tools, machinery and equipment
 workplace environment
 other considerations.
Common body stressing injuries
Common injuries may include:

 sprains and strains of muscles, ligaments and tendons
 back injuries
 joint and bone injuries or degeneration
 nerve injuries or compression, or
 chronic pain
Body stressing warning signs
There are a range of body stressing injury symptoms including:

 muscular pain, sore joints, tingling, burning, inflammation and cramp
 loss of grip strength
 reduced mobility
 feeling overwhelmed at work
 lack of concentration
 not being able to complete tasks
 regular feelings of fatigue
 sleep disturbance
 stress and pain affecting mood, work, family and social life.
Seeking help for body stressing
Seek early support if you think you may develop a body stressing injury:
 Talk to your manager, human resources personnel, a health and
safety representative, a colleague or your general practitioner
 Actively seek information, guidance or training on working safely
 Use any equipment or tools provided to reduce exposure to body
stressing hazard
 Take regular breaks – stand up, sit less and move more
 Use the Body Stressing Sources of Risk checklist (to address any
risks.
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Confined Spaces
Confined spaces are enclosed or partly enclosed spaces that are not
designed for people to work in, but in which people need to work inside
occasionally.
They can have poor ventilation and are a risk to health and safety from
dangerous oxygen levels and contaminants like airborne gases, vapours and
dusts.
Electricity
Electric shock through poor electrical installation and faulty appliances can
cause serious injury and even death. It can result in:
 death from electrocution

 burn injuries to skin and internal tissue as well as damage to the
heart
 other injuries, such as falling from ladders and heights, muscle
spasms, palpitations and unconsciousness.
Heat
Heat strain can result from working in hot temperatures and being exposed
to high levels of humidity or thermal radiation, such as in foundries,
commercial kitchens and laundries.
When working in extreme heat conditions, you must be able to carry out
work without a risk to your health and safety, so far as is reasonably
practicable.
Heights
Working at heights is a high-risk activity and a leading cause of death and

serious injury
Noise
Noise in the workplace is considered excessive when you need to raise your
voice to be heard by someone a meter away.
Excessive noise can lead to temporary or permanent hearing loss or tinnitus

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(ringing in the ears). It can also affect psychological health including anxiety,
depression, fatigue, sleeplessness, memory and decision making.
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Vibration
There are risks connected to working with vibrating equipment and plant
which need to be assessed and managed.
Evidence also shows that people who experience vibration and noise at the
same time are more likely to suffer hearing loss and musculoskeletal
problems, than people exposed to noise or vibration alone.
SOURCE
https://www.comcare.gov.au/safe-healthy-work/prevent-harm/physical-
hazards
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SELF CHECK 3.1-2
1. Which of the following definitely would not be a confined space?

a. A manhole
b. A storage tank
c. A vat
d. A ventilated room
2. The primary hazard associated with confined spaces is:

a. Mechanical or moving parts
b. Sound
c. Heat
d. Oxygen deficiency
3. What is the best way to help prevent slips, trips, and falls?
a. Increase friction between your shoes and the surface
b. Apply an abrasive to the floor that will increase traction
c. Wear shoes with neoprene soles
d. Increase traction on your shoes with sandals and cleats
4. What is not one of the three physical forces that play a part in falls?
a. Momentum
b. Friction
c. Gravity
d. Density
5. What are the hazards of electricity?

a. Shock
b. Burns
c. Arc-blast
d. Explosions
e. Fires
f. All of the above
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ANSWER KEY 3.1-2
1. D
2. D
3. B
4. A
5. F
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COMMON COMPETENCY
“IMMEDIATE RISKS TO SELF AND CASUALTY”
INTRODUCTION
In any first aid situation it is essential that you take precautions to ensure
your own safety and the safety of others. Potential risks of illness and/or
injury can present in any first aid situation and may result from:
 exposure to blood, vomit and other body fluids

 acts of aggression
 an unsafe scene, for example, oncoming traffic in a road accident, or
fallen power lines
 bystanders placing themselves and others at risk of injury
 back, neck or shoulder injuries sustained when moving objects
 the presence of smoke, fire or poisonous fumes.
Tips for taking care of yourself and others:
 always assess for any potential dangers and ensure the area is safe
before approaching
 use standard precautions, such as wearing gloves, to protect yourself
from potential contact with blood and other body fluids
 do not unnecessarily move the casualty or heavy objects
 observe and manage bystanders
 seek professional counselling and debriefing, if required.
Standard precautions
100
Standard precautions are a set of guidelines that assist first aid officers
protect themselves from accidental exposure to blood or other body fluids
during the provision of first aid. Standard precautions include wearing
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COMMON COMPETENCY
gloves when in contact with blood and body fluids and using a disposable
mask when giving rescue breaths to the unconscious casualty who shows
no signs of life.
General principles for protecting yourself as a first aider:

 Wear gloves whenever there is the potential for contact with blood or
other body fluids.
 Wash hands or other skin surfaces thoroughly with soap and water if
they are contaminated with blood or other body fluids.
 Wash eyes with running water if they are splashed with blood or body
fluids.
 Avoid accidental injuries, for example, cuts from broken glass.
 Encourage the casualty to treat themselves where possible. For
example, the casualty may be able to apply direct pressure to their
own bleeding wound.
 Use Personal Protective Equipment (PPE) where available, for example,
gloves, face shields, masks and goggles.
 Dispose of waste materials and sharps appropriately.
Observe and manage bystanders
Bystanders are the people who are in the immediate area of the accident
scene. Many bystanders might have witnessed the incident and might be
extremely anxious or in a state of shock and unable to protect themselves
from any dangers. It might be necessary to assist bystanders to a safe place
and to offer shelter, warmth and reassurance. Bystanders who are in shock
and/or are grieving might need emotional support. Preferably this should be
offered by a trained counsellor. Some bystanders have even been known to
act heroically, placing their own safety at risk in order to assist in some way.
Some people act without thinking in emergency situations and try to

implement first aid management that might be incorrect or even dangerous.
It is important that bystanders are given clear directions and are made to
feel that they can contribute to the management of the situation. Sometimes
making suggestions as to how bystanders can help can prevent people from
acting inappropriately.
Moving the casualty
Moving the casualty should be avoided in most circumstances. This is

especially true if the casualty has sustained any potential injuries to the
head, neck, back or spine. Moving the casualty unnecessarily may cause
further injuries to the casualty and may cause back, neck or shoulder
injuries to the people attempting the move. Moving the casualty should only
take place if you are unable to provide life saving measures in the current
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position or if there are any immediate threats to life, for example, fire and
explosion.
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Road accidents
Car accident
In most circumstances, try to provide first aid care to the casualties in the
vehicle, but only if it is safe to do so. Removal of a casualty from a vehicle
should only take place if you are unable to provide life saving measures in
the current position or if there are any immediate threats to life such as fire
and explosion.
Motorbike accident
Motorbike helmets can provide support to the head, neck and spine and
should only be removed if it is impossible to maintain an open airway or give
life saving measures with the helmet in place. If removal of the helmet is
required, it is preferable that an ambulance officer or other trained person
does this.
SOURCE
https://sielearning.tafensw.edu.au/MCS/FirstAid_Ultimo/firstaid/lo/5251/
5251_01.htm
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SELF CHECK 3.1-3
1. A situation in which a decision maker knows all of the possible outcomes

of a decision and also knows the probability associated with each outcome is
referred to as
a. certainty
b. risk
c. uncertainty
d. strategy
2. Which of the following methods of selecting a strategy is consistent with

risk averting behavior?
a. If two strategies have the same expected profit, select the one with the
smaller standard deviation
b. If two strategies have the same standard deviation, select the one with
the smaller expected profit
c. Select the strategy with the larger coefficient of variation
d. All of the above are correct
3. Which one of the following does measure risk?

a. Coefficient of variation
b. Standard deviation
c. Expected value
d. All of the above are measures of risk
4. If a person's utility doubles when their income doubles, then that person
is risk
a. averse
b. neutral
c. seeking
d. There is not enough information given in the question to determine an
answer
5. The coefficient of variation measures

a. the risk per unit of expected payoff
b. the risk-adjusted expected value
c. the payoff per unit of risk
d. a decision maker's risk-return tradeoff
6. A situation in which a decision maker must choose between strategies

that have more than one possible outcome when the probability of each
outcome is unknown is referred to as
a. diversification
b. certainty
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c. risk
d. uncertainty
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7. If a decision maker is risk averse, then the best strategy to select is the
one that yields the
a. highest expected payoff
b. lowest coefficient of variation
c. highest expected utility
d. lowest standard deviation
8. Circumstances that influence the profitability of a decision are referred to

as
a. strategies
b. a payoff matrix
c. states of nature
d. the marginal utility of money
9. The marginal utility of money diminishes for a decision maker who is

a. a risk seeker
b. risk neutral
c. a risk averter
d. in a situation of uncertainty
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ANSWER KEY 3.1-3
1. B
2. A
3. C
4. B
5. A
6. D
7. C
8. C
9. C
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“FIRST AID KIT”
INTRODUCTION
It's important to have a well-stocked first aid kit in your home so you can
deal with minor accidents and injuries.
Your first aid kit should be locked and kept in a cool, dry place out of the
reach of children.
Many people also keep a small first aid kit in their car for emergencies.
What should I keep in my first aid kit?
Digital BP apparatus - Digital sphygmomanometers are automated,

providing blood pressure reading without needing someone to operate the
cuff or listen to the blood flow sounds.
Digital thermometer - A thermometer is a device that measures temperature

or a temperature gradient. A thermometer has two important elements: a
temperature sensor in which some change occurs with a change in
temperature; and some means of converting this change into a numerical
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Pulse oximeter - Pulse oximetry is a noninvasive method for monitoring a
person's oxygen saturation. Peripheral oxygen saturation readings are
typically within 2% accuracy of the more desirable reading of arterial oxygen
saturation from arterial blood gas analysis
Cotton balls - Cotton pads are pads made of cotton which are used for
medical or cosmetic purposes. For medical purposes, cotton pads are used
to stop or prevent bleeding from minor punctures such as injections or
venipuncture. They may be secured in place with tape.
Alcohol - is either isopropyl alcohol or ethanol-based liquids, or the

comparable British Pharmacopoeia defined surgical spirit, with isopropyl
alcohol products being the most widely available. Rubbing alcohol is
denatured and undrinkable even if it is ethanol-based, due to the bitterants
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added.
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Disposable gloves (1 box) - Medical gloves are disposable gloves used during
medical examinations and procedures to help prevent cross-contamination
between caregivers and patients.
Disposable mask (1 box) - Surgical masks are disposable, loose-fitting face

masks that cover your nose, mouth, and chin. They're typically used to:
protect the wearer from sprays, splashes, and large-particle droplets.
prevent the transmission of potentially infectious respiratory secretions from
the wearer to others.
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Clinical collar - A cervical collar, also known as a neck brace, is a medical
device used to support a person's neck. It is also applied by emergency
personnel to those who have had traumatic head or neck injuries, and can
be used to treat chronic medical conditions.
Surgical scissors - Surgical scissors are surgical instruments usually used

for cutting. They include bandage scissors, dissecting scissors, iris scissors,
operating scissors, stitch scissors, tenotomy scissors, Metzenbaum scissors,
plastic surgery scissors and Mayo scissors. Surgical scissors are usually
made of stainless steel.
Bandage scissors - or bandage forceps, are scissors that often have an

angled tip with a blunt tip on the bottom blade. This helps in cutting
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bandages without gouging the skin

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COMMON COMPETENCY
Forceps - are a handheld, hinged instrument used for grasping and holding
objects.
Splint - A splint is defined as "a rigid or flexible device that maintains in

position a displaced or movable part; also used to keep in place and protect
an injured part" or as "a rigid or flexible material used to protect,
immobilize, or restrict motion in a part"
Sterile gauze pads - Sterile gauze is the basic tool used to stop bleeding and
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keep wounds clean. It treats small to medium cuts, burns, scrapes, and
other wounds. ... Using a roll of gauze instead of pads gives you a lot more
flexibility with respect to the size and location of the injury.
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COMMON COMPETENCY
Spine board - A spinal board, is a patient handling device used primarily in
pre-hospital trauma care. It is designed to provide rigid support during
movement of a person with suspected spinal or limb injuries. They are most
commonly used by ambulance staff, as well as lifeguards and ski patrollers
Ice bag - Ice packs can help minimize swelling around the injury, reduce
bleeding into the tissues, and reduce muscle spasm and pain. Ice packs are
often used after injuries like ankle sprains have occurred.
Hot water bag - filled with hot water and sealed with a stopper, used to
provide warmth, typically while in bed, but also for the application of heat to
a specific part of the body.
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Medical adhesive tapes - is a type of pressure-sensitive adhesive tape used

in medicine and first aid to hold a bandage or other dressing onto a wound.
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COMMON COMPETENCY
SELF CHECK 3.1-4
1. It is designed to provide rigid support during movement of a person with

suspected spinal or limb injuries.
a. Medical Adhesive Tape
b. Hot Water Bag
c. Spinal Board
d. Sterilize Gauze
2. Used to keep in place and protect an injured part

a. Medical Adhesive Tape
b. Splint
c. Spinal Board
d. Forceps
3. This helps in cutting bandages without gouging the skin

a. Bandage Scissor
b. Splint
c. Spinal Board
d. Forceps
4. Known as a neck brace, is a medical device used to support a person's

neck.
a. Bandage Scissor
b. Splint
c. Spinal Board
d. Cervical Collar
5. Used during medical examinations and procedures to help prevent cross-

contamination between caregivers and patients.
a. Bandage Scissor
b. Medical Gloves
c. Spinal Board
d. Cervical Collar
6. A noninvasive method for monitoring a person's oxygen saturation

a. Pulse Oximetry
b. Medical Gloves
c. Spinal Board
d. Cervical Collar
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COMMON COMPETENCY
ANSWER KEY 3.1-4
1. C
2. B
3. A
4. D
5. B
6. A
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COMMON COMPETENCY
“PRINCIPLES OF BODY SUBSTANCE ISOLATION”
INTRODUCTION
What is Body Substance Isolation (BSI) and why it is important? BSI

basically means protecting yourself from germs and bacteria found in bodily
fluids like blood, urine, mucus, feces, etc. As personal caregivers, we are
exposed to these substances on a daily basis. Here are a few safety tips:
 Handwashing is one of the best ways to keep yourself germ-free.

 Always wear gloves. Using gloves protects your hands while
performing personal care tasks such as bathing, toileting, cleaning the
bathroom, even doing laundry and washing dishes. When these duties
are performed, everything that‘s touched can carry germs and
bacteria. Also, it is good protocol to change gloves to avoid cross-
contamination.
 Wear a mask if you or the person you are caring for is coughing or
sneezing.
 Gowns and booties are good for protection for your clothes, usually
only needed for extremely contagious illnesses.
Even while caring for a family member or friend, these precautions are
necessary because we all carry bacteria and germs on our persons, and
some things (viruses, bacteria, etc.) don‘t need to be shared.
Are routine practices different from universal precautions,

body substance isolation, and standard precautions?
Universal precautions are a set of strategies developed to prevent of

transmission of blood borne pathogens. The focus of universal precautions
is on blood and selected body fluids such as cerebrospinal fluid, pleural
fluid, and amniotic fluid. Body secretions such as urine, vomit, feces, or
sputum are not controlled under universal precautions, and are instead
usually covered under a set of guidelines called body substance isolation.
Routine practices are a combination of universal precautions and body

substance isolation. Routine practices have a much bigger scope and aim to
protect against the transmission of all microorganisms through contact with
all body fluids, excretions, mucous membranes, non-intact skin and soiled
items in addition to precautions for blood.
Standard precautions is a term widely adopted in the United States and

convey the same set of principles as routine practices.
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What are the components of routine practices?
There are 5 major components to routine practices. They are risk

assessment, hand hygiene, personal protective equipment, environmental
and administrative controls.
1. Risk Assessment
Before any task is performed, conduct a risk assessment to evaluate the risk
of disease transmission. The risk assessment should take into account the
following:
 Time it takes to complete the task.
 Type of body fluids that the worker may come into contact with.
 Presence of microorganisms in the bodily fluids.
 Route of potential exposure to these microorganisms.
 Susceptibility of the worker to these microorganisms.
 Environment in which the task is carried out.
Appropriate strategies such as hand hygiene, waste management, and the

use of personal protective equipment are then selected to reduce the risk of
exposure and disease transmission.
Suggest the following questions for healthcare providers to ask while

assessing the risk:
1. What task am I going to perform?

2. What is the risk of exposure to:
 Blood and body fluids including respiratory secretions?
 Non-intact skin?
 Mucous membranes?
 Body tissues?
 Contaminated equipment?
3. How competent/experienced am I in performing this task?
4. Will the patient be cooperative while I perform the task?
2. Hand Hygiene
Hand hygiene is the act of removing or destroying microorganisms on the

hands while maintaining good hand integrity (keeping the skin healthy).
Hand hygiene can be performed with an alcohol-based hand sanitizer (when
hands are not visibly soiled) or with soap and water (especially when hands
are visibly soiled).
In healthcare settings, alcohol-based hand sanitizer is preferred when hands

are not visibly soiled. For healthcare providers, using sanitizer is said to
take less time than hand washing, and the mechanical rubbing action is
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important to kill transient bacteria. The sanitizer is also less drying to the
skin when hands are cleaned repetitively. The sanitizer should contain
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COMMON COMPETENCY
3. Personal Protective Equipment (PPE)
PPE includes gloves, gowns, lab coats, shoe covers, goggles, glasses with
side shields, masks, and resuscitation bags. PPE is particularly needed
when disease transmission may occur through touching, spraying,
aerosolization, or splashing of blood, bodily fluids, mucous membranes,
non-intact skin, body tissues, and contaminated equipment and surfaces.
PPE can help create a barrier between the exposed worker and the source of
microorganisms.
Gloves
Gloves are for single-patient and single-procedure use only. Only disposable
gloves should be used in the prevention of disease transmission. Gloves
must be removed and replaced when they become heavily soiled and when
working between patients and between dirty and clean tasks. Gloves should
always be removed using a glove-to-glove or skin-to-skin technique which
will prevent contaminating the hands.
The use of gloves does not replace the need for hand hygiene. Gloves often
create a moist environment that facilitates the growth of microorganisms.
Hands should be properly washed before the gloves are put on and after the
gloves are removed. Hand hygiene is also needed before and after the
replacement of gloves during a procedure or in between tasks.
Gowns
Gowns can be either reusable or disposable. These steps of gown donning
and removal should be followed:
Gown Donning
 Perform hand hygiene.
 Put gown on, opening to the back.
 Fasten both the neck and waist ties.
Gown Removal
 Unfasten ties and peel gown away from neck.
 Slip fingers of one hand under the wrist cuff and pull hand inside.
 With inside hand, push sleeve off with the other arm.
 Fold dirty-to-dirty and roll into bundle (do not shake).
 Discard in hamper.
Face Protection
Face protection can provide an effective barrier to protect a worker‘s eyes,

nose or mouth from coming into contact with sprays or aerosolized body
fluids. There are different types and combinations of face protection, such as
a mask with safety glasses, goggles, face shield (with safety glasses or
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goggles), or a mask with an attached visor (and safety glasses or goggles).

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Steps to remove PPE
The proper steps when removing PPE are critical to prevent contamination of
the worker with soiled PPE. The removal of PPE should be performed in the
following order:
 Remove gloves.
 Remove gown.
 Remove eye protection.
 Remove mask.
4. Environmental Controls
Environmental control refers to controlling and minimizing the level of
microorganisms in the environment. Environmental control measures
include:
 Consistent and stringent equipment and work area cleaning,

including laundry protocols and schedules.
 Proper disposal of waste such as sharps, biomedical, and pathological
waste.
 Appropriate ventilation and other engineering controls.
 Installation of easily accessible and clearly identified waste containers,
hand hygiene product dispensers, and dedicated hand wash sinks.
 Effective placement and segregation of sources of contamination - This
control includes using single room and private toileting for patients
who soil the environment, or using a "blood work only" biological
cabinet for laboratory work associated with blood samples.
Administrative Controls
Administrative controls include employee training, supervisory competency,

immunization, cough etiquette, workplace policies and procedures that are
strictly enforced, and sufficient staffing. Administrative controls are critical
to ensure that the principles of routine practices are effectively and properly
executed in the workplace.
SOURCE
https://www.paraquad.org/blog/body-substance-isolation-safety-tips/
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COMMON COMPETENCY
SELF CHECK 3.2-1
1. What personal protective equipment is the main focus of body substance

isolation?
a. Gloves
b. Mask
c. Goggles
d. Gown
2. Includes gloves, gowns, lab coats, shoe covers, goggles, glasses with side
shields, masks, and resuscitation bags.
a. CED
b. PPE
c. PPA
d. COD
3. The risk assessment should take into account the following except
a. Time it takes to complete the task
b. Type of body fluids that the worker may come into contact with
c. Presence of microorganisms in the bodily fluids
d. Route of potential exposure to these microorganisms
e. Body Tissues
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COMMON COMPETENCY
ANSWER KEY 3.2-1
1. What personal protective equipment is the main focus of body substance
isolation?
a. Gloves
b. Mask
c. Goggles
d. Gown
2. Includes gloves, gowns, lab coats, shoe covers, goggles, glasses with side
shields, masks, and resuscitation bags.
a. CED
b. PPE
c. PPA
d. COD
3. The risk assessment should take into account the following except
a. Time it takes to complete the task
b. Type of body fluids that the worker may come into contact with
c. Presence of microorganisms in the bodily fluids
d. Route of potential exposure to these microorganisms
e. Body Tissues
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COMMON COMPETENCY
“LEVEL OF CONSCIOUSNESS”
INTRODUCTION
The normal state of consciousness comprises either the state of

wakefulness, awareness, or alertness in which most human beings function
while not asleep or one of the recognized stages of normal sleep from which
the person can be readily awakened.
The abnormal state of consciousness is more difficult to define and

characterize, as evidenced by the many terms applied to altered states of
consciousness by various observers. Among such terms are: clouding of
consciousness, confusional state, delirium, lethargy, obtundation, stupor,
dementia, hypersomnia, vegetative state, akinetic mutism, locked-in
syndrome, coma, and brain death. Many of these terms mean different
things to different people, and may prove inaccurate when transmitting and
recording information regarding the state of consciousness of a patient.
Nevertheless, it is appropriate to define several of the terms as closely as
possible.
Clouding of consciousness is a very mild form of altered mental status in

which the patient has inattention and reduced wakefulness.
Confusional state is a more profound deficit that includes disorientation,

bewilderment, and difficulty following commands.
Lethargy consists of severe drowsiness in which the patient can be aroused

by moderate stimuli and then drift back to sleep.
Obtundation is a state similar to lethargy in which the patient has a

lessened interest in the environment, slowed responses to stimulation, and
tends to sleep more than normal with drowsiness in between sleep states.
Stupor means that only vigorous and repeated stimuli will arouse the
individual, and when left undisturbed, the patient will immediately lapse
back to the unresponsive state.
Coma is a state of unarousable unresponsiveness.
It is helpful to have a standard scale by which one can measure levels of

consciousness. This proves advantageous for several reasons:
Communication among health care personnel about the neurologic
condition of a patient is improved; guidelines for diagnostic and therapeutic
intervention in certain situations can be linked to the level of consciousness;
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and in some situations a rough estimate of prognosis can be made based

partly on the scale score. In order for such a scale to be useful it must be
simple to learn, understand, and implement. Scoring must be reproducible
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among observers. The Grady Coma Scale (Table 57.1) has proved functional

COMMON COMPETENCY
in this regard. It has been used for more than 10 years at Grady Memorial
Hospital in Atlanta, Georgia, to gauge the level of consciousness of patients
in the neurosurgical intensive care unit and elsewhere. The grade I patient
is only slightly confused. The grade II patient requires a light pain stimulus
(such as a sharp pin tapped lightly over the chest wall) for appropriate
arousal, or may be combative or belligerent. The grade III patient is
comatose but will ward off deeply painful stimuli such as sternal pressure or
nipple twist with an appropriate response. The grade IV patient reacts
inappropriately with either decorticate or decerebrate posturing to such
deeply painful stimuli, and the grade V patient remains flaccid when
similarly stimulated.
Many other coma scales have been developed. Most are tailored to specific
subsets of patients and are designed not only to reflect level of
consciousness but also to include additional data so that more reliable
comparisons can be made for research purposes or more reliable prognostic
determinations can be made. An example of such a scale is the Glasgow
Coma Scale (Table 57.2). In this scale the normal state merits a score of 15,
and as level of consciousness deteriorates, the score becomes less.
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Technique
The technique of evaluation of the patient with an altered level of

consciousness can be divided into three phases. The first is to determine the
level of consciousness itself. Second is evaluation of the patient, searching
carefully for hints as to the cause of the confusion or coma. Third is the
presence or absence of focality of the disorder, both in terms of the level of
dysfunction within the rostrocaudal neuraxis and specific involvement of
cortical or brainstem structures.
After the physician makes sure that no immediate life-threatening

emergency such as airway obstruction or shock is present, the examination
begins with observation of the patient. What is the position of the patient?
Does the patient have one or more extremities positioned in an unusual
manner, which might suggest paralysis or spasticity? Are the eyes opened or
closed? Does the person acknowledge your presence, or is he or she
oblivious to it? If the patient is alert, acknowledges the presence of the
examiner, seems well oriented to time and place and not confused on
general questioning, then the level of consciousness would be considered
normal. Thus one can have a normal level of consciousness yet be of
subnormal intellectual capability, have a focal neurologic deficit such as an
aphasia or hemiparesis, or exhibit abnormal thought content such as a
schizophrenic patient might.
As the patient's name is called in a normal tone of voice or if, during an

attempt at a simple conversation, it is noted that the person is confused,
drowsy, or indifferent, an abnormal level of consciousness exists. Individuals
who respond with recognition when their name is called and do not lapse
into sleep when left undisturbed, can be said to be in a grade I coma. If the
alteration in level of consciousness is more severe, so that the person lapses
into sleep when not disturbed and is arousable only when a pin is tapped
gently over the chest wall, the grade of coma is II. This category also
includes the patient who is organically disoriented, belligerent, and
uncooperative (as can be seen in various states of intoxication), or in the
young adult with moderately severe head injury.
If such efforts as calling the patient's name in a normal tone of voice or

pricking the skin over the chest wall lightly with a pin result in no response,
the examiner must choose a deeper pain stimulus. My preference is a pinch
or slight twist of the nipple. Other options include sternal pressure, which
may be applied with the fisted knuckle, or squeezing the nailbed. The slight
periareolar bruising from repetitive nipple twisting is much less problematic
to the eventually recovered patient than the chronically painful
subperiosteal or subungual hemorrhage from the latter options. Under no
circumstances should one apply such a painful stimulus as irrigation of the
ears with ice water until the status of the intracranial pressure is known.
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The patient's response to the deep pain stimulus is then noted. A patient
who winces and/or attempts to ward off the deep pain stimulus
appropriately can be said to be in a grade III coma.
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The deep pain stimulus may, however, result in abnormal postural reflexes,
either unilateral or bilateral. The two most common are decorticate and
decerebrate posturing. In both states, the lower extremity exhibits extension
at the knee and internal rotation and plantar flexion at the ankle. In
decorticate posturing, the upper extremity is held adducted at the shoulder
and flexed at the elbow, wrist, and metacarpal-phalangeal joints. In the
decerebrate state, the upper extremity is adducted at the shoulder and
rigidly extended and internally rotated at the elbow. In either case, the
patient exhibiting such posturing to a deep pain stimulus is rated a grade IV
coma. The patient who maintains a state of flaccid unresponsiveness despite
deep pain stimulation is a grade V coma.
Once the level of consciousness is determined, a careful check for hints as

to the cause of the alteration in level of consciousness should be
undertaken. In most instances the history (which can be obtained from the
patient or those who accompany him, or from available medical records) is
more valuable than is the examination. History is not always available,
however, and in all instances a careful examination is merited. Vital signs
may obviously suggest infection, hypertension, shock, or increased
intracranial pressure with bradycardia. Is there evidence of trauma to the
head or elsewhere? Inspect the scalp thoroughly for abrasions or
contusions, and if blood is seen, explain it even if it means shaving part of
the scalp to do so. Is there periorbital or retroauricular ecchymosis, or is
there blood behind the tympanic membrane to suggest basilar skull
fracture? Is there papilledema or intraocular hemorrhage? Is the conjunctiva
icteric, the liver enlarged, or does the patient have asterixis? Are the lips or
nailbeds discolored or pale so as to suggest anemia or pulmonary
dysfunction? Is the neck stiff—a warning of meningitis or subarachnoid
hemorrhage. Is there anything to suggest intoxication with drugs or poisons,
such as an unusual odor to the breath or body or pinpoint pupils?
The next step is to try to localize the problem that is resulting in alteration
of consciousness, first by trying to localize the dysfunction to a level within
the rostrocaudal neuraxis and second by searching for focal clues such as
specific cranial nerve deficits, abnormal reflexes, or motor asymmetry.
The level of consciousness determines to a certain extent the level of

functional disturbance within the neuraxis. A patient who qualifies as a
grade I or II has cortical or diencephalic dysfunction. The grade III patient
has physiologic dysfunction above the midbrain. Grade IV coma indicates
dysfunction above the levels of the cerebral peduncles or pons, and with
grade V coma the medulla may be all that is working. Observation of the
pattern of respiration may further support the examiner's impression of
dysfunctional level (Table 57.3). Cheyne-Stokes respiration means trouble at
or above the diencephalon; central neurogenic hyperventilation (which is
rare) points to difficulty at the upper midbrain; apneustic respiration
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suggests functional pontine deficit; and an ataxic breathing pattern suggests

dorso-medial medullary dysfunction. Observation of the rate, pattern, and
depth of respiration over at least several minutes is necessary to document
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such alterations. Like respiratory patterns, the size and reactivity of the

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pupils can be used to substantiate further the level of dysfunction within
the neuraxis (Table 57.4). Small reactive pupils suggest diencephalic
localization, frequently on a metabolic basis. Large pupils that dilate and
contract automatically (hippus) but do not react to direct light stimulus
suggest a tectal lesion. Midposition fixed pupils localize to the midbrain.
Bilateral pinpoint pupils are indicative of pontine trouble.
Examination of the so-called brainstem reflexes is of utmost importance in

evaluation of the patient in grade III, IV, or V coma (Table 57.5). All rely on
integrity of centers within the pons or dorsal midbrain. As emphasized
earlier, the cold-water caloric test should not be done until the status of the
patient's intracranial pressure is known. Irrigation of the eardrum with ice
water causes such pain that the patient's Valsalva response may be enough
to initiate herniation in the already tenuous situation of markedly increased
intracranial pressure. Suggested methods for testing these reflexes are
outlined in Table 57.5.
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Further examination may be productive in revealing findings such as a

unilateral dilated pupil, a focal cranial nerve deficit, an asymmetry of
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movement suggesting a hemiparesis, abnormal movements suggesting

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seizure activity, a reflex asymmetry, or a focal sensory abnormality that will
help further localize the area of trouble within the central nervous system.
The specific techniques for such examination are covered elsewhere.
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SELF CHECK 3.2-2
1. The easy problem of consciousness can be solved by

a. defining different conscious experiences in terms of different brain
states
b. asking participants to be introspective during conscious experiences
c. focusing on people‘s subjective conscious experiences
d. defining how unconscious perceptions appear to be conscious
2. Accounting for differences in subjective experiences among people is the

a. hard problem of consciousness
b. easy problem of consciousness
c. qualia of consciousness
d. unconscious part of experience
3. If you are arguing with your friend about whether you both have the same
subjective experience of the beauty of a particular painting, you are talking
about
a. objectivity
b. qualia
c. the easy problem of consciousness
d. split-brained phenomena
4. A split-brained patient is so named because his or her _______ has been

severed in order to limit the severity of seizures.
a. thalamus
b. hypothalamus
c. frontal lobe
d. corpus callosum
5. Experiments with split-brained patients have illustrated that

a. it is impossible to speak without two connected cerebral hemispheres
b. the left hemisphere is the less dominant, non-verbal hemisphere
c. information cannot be processed in the right hemisphere in these
patients
d. consciousness is not dependent on the language center of the brain
6. Circadian rhythms are regulated by the _______ of the hypothalamus.

a. ventromedial nucleus
b. suprachiasmatic nucleus
c. anterior portion
d. lateral section
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ANSWER KEY 3.2-2
1. A
2. A
3. B
4. D
5. D
6. B
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“POTENTIALLY LIFE- THREATENING CONDITION”
INTRODUCTION
Unconsciousness - first aid
Unconsciousness is when a person is unable to respond to people and

activities. Doctors often call this a coma or being in a comatose state.
Other changes in awareness can occur without becoming unconscious.

These are called altered mental status or changed mental status. They
include sudden confusion, disorientation, or stupor.
Unconsciousness or any other sudden change in mental status must be

treated as a medical emergency.
Causes
Unconsciousness can be caused by nearly any major illness or injury. It can
also be caused by substance (drug) and alcohol use. Choking on an object
can result in unconsciousness as well.
Brief unconsciousness (or fainting) is often a result from dehydration, low
blood sugar, or temporary low blood pressure. It can also be caused by
serious heart or nervous system problems. A doctor will determine if the
affected person needs tests.
Other causes of fainting include straining during a bowel movement
(vasovagal syncope), coughing very hard, or breathing very fast
(hyperventilating).
Symptoms
The person will be unresponsive (does not respond to activity, touch, sound,
or other stimulation).
The following symptoms may occur after a person has been

unconscious:
 Amnesia for (not remembering) events before, during, and even after
the period of unconsciousness
 Confusion
 Drowsiness
 Headache
 Inability to speak or move parts of the body (stroke symptoms)
 Lightheadedness
 Loss of bowel or bladder control (incontinence)
 Rapid heartbeat (palpitations)
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 Slow heartbeat
 Stupor (severe confusion and weakness)
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If the person is unconscious from choking, symptoms may include:
 Inability to speak
 Difficulty breathing
 Noisy breathing or high-pitched sounds while inhaling
 Weak, ineffective coughing
 Bluish skin color
Being asleep is not the same as being unconscious. A sleeping person will
respond to loud noises or gentle shaking. An unconscious person will not.
First Aid
If someone is awake but less alert than usual, ask a few simple questions,
such as:
 What is your name?
 What is the date?
 How old are you?
Wrong answers or not being able to answer the question suggest a change in
mental status.
If a person is unconscious or has a change in mental status, follow these

first aid steps:
1. Call an emergency hotline
2. Check the person's airway, breathing, and pulse frequently. If
necessary, begin CPR.
3. If the person is breathing and lying on their back, and you do not
think there is a spinal injury, carefully roll the person toward you onto
their side. Bend the top leg so both hip and knee are at right angles.
Gently tilt their head back to keep the airway open. If breathing or
pulse stops at any time, roll the person onto their back and begin
CPR.
4. If you think there is a spinal injury, leave the person where you found
them (as long as breathing continues). If the person vomits, roll the
entire body at one time to their side. Support their neck and back to
keep the head and body in the same position while you roll.
5. Keep the person warm until medical help arrives.
6. If you see a person fainting, try to prevent a fall. Lay the person flat on
the floor and raise their feet about 12 inches (30 centimeters).
7. If fainting is likely due to low blood sugar, give the person something
sweet to eat or drink only when they become conscious.
If the person is unconscious from choking:

 Begin CPR. Chest compressions may help dislodge the object.
 If you see something blocking the airway and it is loose, try to remove
it. If the object is lodged in the person's throat, DO NOT try to grasp it.
This can push the object farther into the airway.
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 Continue CPR and keep checking to see if the object is dislodged until
medical help arrives.
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DO NOT
 DO NOT give an unconscious person any food or drink.
 DO NOT leave the person alone.
 DO NOT place a pillow under the head of an unconscious person.
 DO NOT slap an unconscious person's face or splash water on their
face to try to revive them.
When to Contact a Medical Professional
Call emergency hotline if the person is unconscious and:

 Does not return to consciousness quickly (within a minute)
 Has fallen down or been injured, especially if they are bleeding
 Has diabetes
 Has seizures
 Has lost bowel or bladder control
 Is not breathing
 Is pregnant
 Is over age 50
Call emergency hotline if the person regains consciousness, but:

 Feels chest pain, pressure, or discomfort, or has a pounding or
irregular heartbeat
 Cannot speak, has vision problems, or cannot move their arms and
legs
Prevention
To prevent becoming unconscious or fainting:

 Avoid situations where your blood sugar level gets too low.
 Avoid standing in one place too long without moving, especially if you
are prone to fainting.
 Get enough fluid, particularly in warm weather.
 If you feel like you are about to faint, lie down or sit with your head
bent forward between your knees.
If you have a medical condition, such as diabetes, always wear a medical

alert necklace or bracelet.
Alternative Names
Loss of consciousness - first aid; Coma - first aid; Mental status change;
Altered mental status; Syncope - first aid; Faint - first aid
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Syncope (Fainting)
Syncope is a temporary loss of consciousness usually related to insufficient

blood flow to the brain. It's also called fainting or "passing out."
It most often occurs when blood pressure is too low (hypotension) and the
heart doesn't pump enough oxygen to the brain. It can be benign or a
symptom of an underlying medical condition.
What causes syncope?

Syncope is a symptom that can be due to several causes, ranging from
benign to life-threatening conditions. Many non life-threatening factors,
such as overheating, dehydration, heavy sweating, exhaustion or the pooling
of blood in the legs due to sudden changes in body position, can trigger
syncope. It's important to determine the cause of syncope and any
underlying conditions.
However, several serious heart conditions, such as bradycardia, tachycardia

or blood flow obstruction, can also cause syncope.
What is neurally mediated syncope?

Neurally mediated syncope (NMS) is the most common form of fainting and a
frequent reason for emergency department visits. It's also called reflex,
neurocardiogenic, vasovagal (VVS) or vasodepressor syncope. It's benign and
rarely requires medical treatment.
NMS is more common in children and young adults, though it can occur at
any age. It happens when the part of the nervous system that regulates
blood pressure and heart rate malfunctions in response to a trigger, such as
emotional stress or pain.
NMS typically happens while standing and is often preceded by a sensation

of warmth, nausea, lightheadedness, tunnel vision or visual "grayout."
Placing the person in a reclining position restores blood flow and
consciousness, and ends the seizure.
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Situational syncope, which is a type of NMS, is related to certain physical

functions, such as violent coughing (especially in men), laughing or
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Other disorders can cause syncope, which also can be a side effect of some
medicines.
Some types of syncope suggest a serious disorder:

 Those occurring with exercise
 Those associated with palpitations or irregularities of the heart
 Those associated with family history of recurrent syncope or sudden
death
Respiratory arrest
What happens if you come upon a patient who has a strong, regular pulse,
but it is not breathing? This person is in respiratory arrest, and while it is
similar to cardiac arrest, it is managed slightly differently and therefore
deserves to be discussed separately.
What is respiratory arrest?

Respiratory arrest is a condition that exists at any point a patient stops
breathing or is ineffectively breathing. It often occurs at the same time as
cardiac arrest, but not always. In the context of advanced cardiovascular life
support, however, respiratory arrest is a state in which a patient stops
breathing but maintains a pulse. Importantly, respiratory arrest can exist
when breathing is ineffective, such as agonal gasping.
What causes respiratory arrest?

We often think of cardiac arrest leading to respiratory arrest, but the
respiratory system may shut down without the heart‘s involvement. If the
nerves and/or muscles are not capable of supporting respiration, a patient
may enter respiratory arrest. One example of this is in the disease
amyotrophic lateral sclerosis (Lou Gehrig‘s disease). If the area of the brain
that controls respiration becomes depressed, as might occur in an opioid
overdose, the brain does not drive respiration. Another example is a state in
which the chest might not be able to physically support respiration. This
might occur externally (e.g., with a crush injury to the chest) or internally
(e.g., in acute respiratory distress syndrome or tension pneumothorax). It is
important to keep these possible causes of respiratory arrest in mind during
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resuscitation.
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Cardiac arrest
Cardiac arrest is a sudden loss of blood flow resulting from the failure of the
heart to pump effectively. Signs include loss of consciousness and abnormal
or absent breathing.
Why do cardiac arrests happen?

Most cardiac arrests occur when a diseased heart's electrical system
malfunctions. This malfunction causes an abnormal heart rhythm such as
ventricular tachycardia or ventricular fibrillation. Some cardiac arrests are
also caused by extreme slowing of the heart's rhythm (bradycardia).
Symptoms
Signs of sudden cardiac arrest are immediate and drastic and include:
 Sudden collapse
 No pulse
 No breathing
 Loss of consciousness
Sometimes other signs and symptoms occur before sudden cardiac arrest.
These might include:

 Chest discomfort
 Shortness of breath
 Weakness
 Fast-beating, fluttering or pounding heart (palpitations)
But sudden cardiac arrest often occurs with no warning.

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Casualty who has life threatening condition that involves C-
A-B (Compression – Airways – Breathing).
Treat this victim first and transport as soon as possible
1. Airway and breathing difficulties
Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful

in many emergencies, such as a heart attack or near drowning, in which
someone's breathing or heartbeat has stopped. The American Heart
Association recommends starting CPR with hard and fast chest
compressions. This hands-only CPR recommendation applies to both
untrained bystanders and first responders.
If you're afraid to do CPR or unsure how to perform CPR correctly, know

that it's always better to try than to do nothing at all. The difference between
doing something and doing nothing could be someone's life.
Here's advice from the American Heart Association:
 Untrained. If you're not trained in CPR or worried about giving rescue

breaths, then provide hands-only CPR. That means uninterrupted
chest compressions of 100 to 120 a minute until paramedics arrive.
You don't need to try rescue breathing.
 Trained and ready to go. If you're well-trained and confident in your
ability, check to see if there is a pulse and breathing. If there is no
pulse or breathing within 10 seconds, begin chest compressions. Start
CPR with 30 chest compressions before giving two rescue breaths.
 Trained but rusty. If you've previously received CPR training but
you're not confident in your abilities, then just do chest compressions
at a rate of 100 to 120 a minute.
2. Choking
Choking is a blockage of the upper airway by food or other objects, which

prevents a person from breathing effectively. Choking can cause a simple
coughing fit, but complete blockage of the airway may lead to death.
Choking is a true medical emergency that requires fast, appropriate action
by anyone available.
Choking is a true medical emergency that requires fast, appropriate

action by anyone available. Emergency medical teams may not arrive
in time to save a choking person's life.
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Breathing is an essential part of life. When we inhale, we breathe in a mix of
nitrogen, oxygen, carbon dioxide, and other gases.
1. In the lungs, oxygen enters the bloodstream to travel to the rest of the
body. Our bodies use oxygen as a fuel source to make energy from the
food we eat. Carbon dioxide, a waste product, enters the bloodstream
and travels back to the lungs.
2. When we exhale, we breathe out carbon dioxide, nitrogen, and oxygen.
3. When someone is choking with a completely blocked airway, no
oxygen can enter the lungs. The brain is extremely sensitive to this
lack of oxygen and begins to die within four to six minutes. It is
during this time that first aid must take place. Irreversible brain death
occurs in as little as 10 minutes.
What Causes Choking?
Choking is caused when a piece of food or other object gets stuck in the
upper airway.
In the back of the mouth are two openings. One is the esophagus, which
leads to the stomach; food goes down this pathway. The other is the trachea,
which is the opening air must pass through to get to the lungs. When
swallowing occurs, the trachea is covered by a flap called the epiglottis,
which prevents food from entering the lungs. The trachea splits into the left
and right mainstem bronchus. These lead to the left and right lungs. They
branch into increasingly smaller tubes as they spread throughout the lungs.
Any object that ends up in the airway will become stuck as the airway
narrows. Many large objects get stuck just inside the trachea at the vocal
cords.
In adults, choking most often occurs when food is not chewed properly.
Talking or laughing while eating may cause a piece of food to "go down the
wrong pipe." Normal swallowing mechanisms may be slowed if a person has
been drinking alcohol or taking drugs and if the person has certain illnesses
such as Parkinson's disease.
 In older adults, risk factors for choking include advancing age, poorly
fitting dental work, and alcohol consumption.
 In children, choking is often caused by chewing food incompletely,
attempting to eat large pieces of food or too much food at one time, or
eating hard candy. Children also put small objects in their mouths,
which may become lodged in their throat. Nuts, pins, marbles, or
coins, for example, create a choking hazard.
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3. Uncontrolled and severe bleeding
For severe bleeding, take these first-aid steps and reassure the injured
person.
1. Remove any clothing or debris on the wound. Don't remove large or

deeply embedded objects. Don't probe the wound or attempt to clean it
yet. Your first job is to stop the bleeding. Wear disposable protective
gloves if available.
2. Stop the bleeding. Place a sterile bandage or clean cloth on the
wound. Press the bandage firmly with your palm to control bleeding.
Apply constant pressure until the bleeding stops. Maintain pressure
by binding the wound with a thick bandage or a piece of clean cloth.
Don't put direct pressure on an eye injury or embedded object.
Secure the bandage with adhesive tape or continue to maintain

pressure with your hands. If possible, raise an injured limb above the
level of the heart.
3. Help the injured person lie down. If possible, place the person on a
rug or blanket to prevent loss of body heat. Calmly reassure the
injured person.
4. Don't remove the gauze or bandage. If the bleeding seeps through
the gauze or other cloth on the wound, add another bandage on top of
it. And keep pressing firmly on the area.
5. Tourniquets: A tourniquet is effective in controlling life-threatening
bleeding from a limb. Apply a tourniquet if you're trained in how to do
so. When emergency help arrives, explain how long the tourniquet has
been in place.
6. Immobilize the injured body part as much as possible. Leave the
bandages in place and get the injured person to an emergency room
as soon as possible.
4. Decreased level of consciousness
The major characteristics of consciousness are alertness and being oriented

to place and time. Alertness means that you‘re able to respond appropriately
to the people and things around you. Being oriented to place and time
means that you know who you are, where you are, where you live, and what
time it is.
When consciousness is decreased, your ability to remain awake, aware, and

oriented is impaired. Impaired consciousness can be a medical emergency.
Symptoms of decreased consciousness

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Symptoms that may be associated with decreased consciousness include:

 seizures
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 loss of bowel or bladder function

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 poor balance
 falling
 difficulty walking
 fainting
 lightheadedness
 irregular heartbeat
 rapid pulse
 low blood pressure
 sweating
 fever
 weakness in the face, arms, or legs
5. Shock (different types)
Shock is a life-threatening condition that occurs when the body is not

getting enough blood flow. Lack of blood flow means the cells and organs do
not get enough oxygen and nutrients to function properly. Many organs can
be damaged as a result. Shock requires immediate treatment and can get
worse very rapidly. As many 1 in 5 people who suffer shock will die from it.
The main types of shock include:

1. Cardiogenic shock (due to heart problems)
2. Hypovolemic shock (caused by too little blood volume)
3. Anaphylactic shock (caused by allergic reaction)
4. Septic shock (due to infections)
5. Neurogenic shock (caused by damage to the nervous system)
Causes
Shock can be caused by any condition that reduces blood flow, including:
 Heart problems (such as heart attack or heart failure)
 Low blood volume (as with heavy bleeding or dehydration)
 Changes in blood vessels (as with infection or severe allergic reactions)
 Certain medicines that significantly reduce heart function or blood
pressure
Shock is often associated with heavy external or internal bleeding from a

serious injury. Spinal injuries can also cause shock.
Toxic shock syndrome is an example of a type of shock from an infection.
Symptoms
A person in shock has extremely low blood pressure. Depending on the

specific cause and type of shock, symptoms will include one or more of the
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following:
 Anxiety or agitation/restlessness
 Bluish lips and fingernails
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 Confusion
 Dizziness, lightheadedness, or faintness
 Pale, cool, clammy skin
 Low or no urine output
 Profuse sweating, moist skin
 Rapid but weak pulse
 Shallow breathing
 Being unconscious (unresponsive)
First Aid
Take the following steps if you think a person is in shock:

 Call the local emergency number for immediate medical help.
 Check the person's airway, breathing, and circulation. If necessary,
begin rescue breathing and CPR.
 Even if the person is able to breathe on their own, continue to check
rate of breathing at least every 5 minutes until help arrives.
 If the person is conscious and DOES NOT have an injury to the head,
leg, neck, or spine, place the person in the shock position. Lay the
person on the back and elevate the legs about 12 inches (30
centimeters). DO NOT elevate the head. If raising the legs will cause
pain or potential harm, leave the person lying flat.
 Give appropriate first aid for any wounds, injuries, or illnesses.
 Keep the person warm and comfortable. Loosen tight clothing.
IF THE PERSON VOMITS OR DROOLS
 Turn the head to one side to prevent choking. Do this as long as you
do not suspect an injury to the spine.
 If a spinal injury is suspected, "log roll" the person instead. To do this,
keep the person's head, neck, and back in line, and roll the body and
head as a unit.
DO NOT
In case of shock:
 DO NOT give the person anything by mouth, including anything to eat
or drink.
 DO NOT move the person with a known or suspected spinal injury.
 DO NOT wait for milder shock symptoms to worsen before calling for
emergency medical help.
When to Contact a Medical Professional
Call the local emergency number any time a person has symptoms of shock.
Stay with the person and follow the first aid steps until medical help arrives.
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Prevention
Learn ways to prevent heart disease, falls, injuries, dehydration, and other
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stings), carry an epinephrine pen. Your health care provider will teach you
how and when to use it.
6. Severe burns (2nd and 3rd degree) with difficulty of

breathing
Burns are one of the most common household injuries, especially among
children. The term ―burn‖ means more than the burning sensation
associated with this injury. Burns are characterized by severe skin damage
that causes the affected skin cells to die.
Most people can recover from burns without serious health consequences,
depending on the cause and degree of injury. More serious burns require
immediate emergency medical care to prevent complications and death.
Burn levels
There are three primary types of burns: first-, second-, and third-degree.
Each degree is based on the severity of damage to the skin, with first-degree
being the most minor and third-degree being the most severe. Damage
includes:
 first-degree burns: red, nonblistered skin

 second-degree burns: blisters and some thickening of the skin
 third-degree burns: widespread thickness with a white, leathery
appearance
There are also fourth-degree burns. This type of burn includes all of the
symptoms of a third-degree burn and also extends beyond the skin into
tendons and bones.
Burns have a variety of causes, including:

 scalding from hot, boiling liquids
 chemical burns
 electrical burns
 fires, including flames from matches, candles, and lighters
 excessive sun exposure
The type of burn is not based on the cause of it. Scalding, for example, can
cause all three burns, depending on how hot the liquid is and how long it
stays in contact with the skin.
Chemical and electrical burns warrant immediate medical attention because

they can affect the inside of the body, even if skin damage is minor.
1. First-degree burn
First-degree burns cause minimal skin damage. They are also called
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―superficial burns‖ because they affect the outermost layer of skin. Signs of
a first-degree burn include:
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 redness
 minor inflammation, or swelling
 pain
 dry, peeling skin occurs as the burn heals
Since this burn affects the top layer of skin, the signs and symptoms
disappear once the skin cells shed. First-degree burns usually heal within 7
to 10 days without scarring.
You should still see your doctor if the burn affects a large area of skin, more
than three inches, and if it‘s on your face or a major joint, which include:
 knee
 ankle
 foot
 spine
 shoulder
 elbow
 forearm
First-degree burns are usually treated with home care. Healing time may be
quicker the sooner you treat the burn. Treatments for a first-degree burn
include:
 soaking the wound in cool water for five minutes or longer
 taking acetaminophen or ibuprofen for pain relief
 applying lidocaine (an anesthetic) with aloe vera gel or cream to soothe
the skin
 using an antibiotic ointment and loose gauze to protect the affected
area
Make sure you don‘t use ice, as this may make the damage worse. Never
apply cotton balls to a burn because the small fibers can stick to the injury
and increase the risk of infection. Also, avoid home remedies like butter and
eggs as these are not proven to be effective.
2. Second-degree burn
Second-degree burns are more serious because the damage extends beyond
the top layer of skin. This type burn causes the skin to blister and become
extremely red and sore.
Some blisters pop open, giving the burn a wet or weeping appearance. Over
time, thick, soft, scab-like tissue called fibrinous exudate may develop over
the wound.
Due to the delicate nature of these wounds, keeping the area clean and
bandaging it properly is required to prevent infection. This also helps the
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Some second-degree burns take longer than three weeks to heal, but most
heal within two to three weeks without scarring, but often with pigment
changes to the skin.
The worse the blisters are, the longer the burn will take to heal. In some
severe cases, skin grafting is required to fix the damage. Skin grafting takes
healthy skin from another area of the body and moves it to the site of the
burned skin.
As with first-degree burns, avoid cotton balls and questionable home

remedies.
Treatments for a mild second-degree burn generally include:

 running the skin under cool water for 15 minutes or longer
 taking over-the-counter pain medication (acetaminophen or ibuprofen)
 applying antibiotic cream to blisters
However, seek emergency medical treatment if the burn affects a

widespread area, such as any of the following:
 face
 hands
 buttocks
 groin
 feet
3. Third-degree burn
Excluding fourth-degree burns, third-degree burns are the most severe.

They cause the most damage, extending through every layer of skin.
There is a misconception that third-degree burns are the most painful.

However, with this type of burn the damage is so extensive that there may
not be any pain because of nerve damage.
Depending on the cause, the symptoms third-degree burns can exhibit

include:
 waxy and white color
 char
 dark brown color
 raised and leathery texture
 blisters that do not develop
Without surgery, these wounds heal with severe scarring and contracture.
There is no set timeline for complete spontaneous healing for third-degree
burns.
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Never attempt to self-treat a third-degree burn. Call the local emergency

hotline immediately. While you‘re waiting for medical treatment, raise the
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injury above your heart. Don‘t get undressed, but make sure no clothing is
stuck to the burn.
Complications
Compared with first- and second-degree burns, third-degree burns carry the
most risk for complications, such as infections, blood loss, and shock, which
is often what could lead to death. At the same time, all burns carry the risk
of infections because bacteria can enter broken skin.
Tetanus is another possible complication with burns of all levels. Like

sepsis, tetanus is a bacterial infection. It affects the nervous system,
eventually leading to problems with muscle contractions. As a rule of
thumb, every member of your household should receive updated tetanus
shots every 10 years to prevent this type of infection.
Severe burns also carry the risk of hypothermia and hypovolemia.

Dangerously low body temperatures characterize hypothermia. While this
may seem like an unexpected complication of a burn, the condition is
actually prompted by excessive loss of body heat from an injury.
Hypovolemia, or low blood volume, occurs when your body loses too much
blood from a burn.
Preventing all degrees of burns

The obvious best way to fight burns is to prevent them from happening.
Certain jobs put you at a greater risk for burns, but the fact is that most
burns happen at home. Infants and young children are the most vulnerable
to burns.
Preventive measures you can take at home include:

 Keep children out of the kitchen while cooking.
 Turn pot handles toward the back of the stove.
 Place a fire extinguisher in or near the kitchen.
 Test smoke detectors once a month.
 Replace smoke detectors every 10 years.
 Keep water heater temperature under 120 degrees Fahrenheit.
 Measure bath water temperature before use.
 Lock up matches and lighters.
 Install electrical outlet covers.
 Check and discard electrical cords with exposed wires.
 Keep chemicals out of reach, and wear gloves during chemical use.
 Wear sunscreen every day, and avoid peak sunlight.
 Ensure all smoking products are stubbed out completely.
 Clean out dryer lint traps regularly.
It‘s also important to have a fire escape plan and to practice it with your
family once a month. In the event of a fire, make sure to crawl underneath
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smoke. This will minimize the risk of passing out and becoming trapped in a
fire.
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SOURCE
https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis--
monitoring-of-arrhythmia/syncope-fainting
https://aclsmedicaltraining.com/respiratory-arrest
https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600
https://www.emedicinehealth.com/choking/article_em.htm
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SELF CHECK 3.2-3
1. Following symptoms may occur after a person has been unconscious

a. Confusion
b. Drowsiness
c. Choking
d. Lightheadedness
2. A condition that exists at any point a patient stops breathing or is

ineffectively breathing. It often occurs at the same time as cardiac arrest,
but not always.
a. Respiratory arrest
b. Syncope
c. Cardiac arrest
d. Breathing
3. This type burn causes the skin to blister and become extremely red and
sore.
a. First-degree burn
b. Second-degree burn
c. Third-degree burn
4. They cause the most damage, extending through every layer of skin.
a. First-degree burn
b. Second-degree burn
c. Third-degree burn
5. A life-threatening condition that occurs when the body is not getting

enough blood flow.
a. Airway and breathing difficulties
b. Choking
c. Uncontrolled and severe bleeding
d. Decreased level of consciousness
e. Shock
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ANSWER KEY 3.2-3
1. C
2. A
3. B
4. C
5. E
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“ACTIVATE MEDICAL ASSISTANCE”
INTRODUCTION
"Medical assistance" means so much of the following medical and remedial

care and services. (Determination of health care and services covered),
including payments made for services provided under an insurance or other
contractual arrangement and money paid directly to the recipient for the
purchase of medical care:
a. Inpatient hospital services, other than services in an institution for

mental diseases;
b. Outpatient hospital services;
c. Other laboratory and X-ray services;
d. Skilled nursing facility services, other than services in an institution

for mental diseases;
e. Physicians' services, whether furnished in the office, the patient's

home, a hospital, a skilled nursing facility or elsewhere;
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f. Medical care, or any other type of remedial care recognized under

state law, furnished by licensed practitioners within the scope of their
practice as defined by state law;
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g. Home health care services;
h. Private duty nursing services;
i. Clinic services;
j. Dental services;
k. Physical therapy and related services;
l. Prescribed drugs, including those dispensed and administered as

provided under ORS chapter 689;
m. Dentures and prosthetic devices; and eyeglasses prescribed by a

physician skilled in diseases of the eye or by an optometrist,
whichever the individual may select;
n. Other diagnostic, screening, preventive and rehabilitative services;
o. Inpatient hospital services, skilled nursing facility services and

intermediate care facility services for individuals 65 years of age or
over in an institution for mental diseases;
p. Any other medical care, and any other type of remedial care
recognized under state law;
q. Periodic screening and diagnosis of individuals under the age of 21

years to ascertain their physical or mental impairments, and such
health care, treatment and other measures to correct or ameliorate
impairments and chronic conditions discovered thereby;
r. Inpatient hospital services for individuals under 22 years of age in an

institution for mental diseases; and
s. Hospice services
Emergency Care Guidelines
1. PLAN OF ACTION
Emergency plan should be established based on anticipated needs and
available resources.
2. GATHERING OF NEEDED MATERIALS

The emergency response begins with the preparation of equipment and
personnel before any emergency occurs
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COMMON COMPETENCY
3. INITIAL RESPONSE
 Ask for HELP.
 Intervene
 Do no further harm.
4. INSTRUCTION TO HELPER/S
Proper information and instruction to a helper/s would provide organized
first aid care.
Emergency action principles
Survey the scene

Once you recognized that an emergency has occurred and decide to act, you
must make sure the scene of the emergency is safe for you, the victim/s,
and any bystander/s.
Elements of the Survey of the Scene:

 Scene safety
 Mechanism of injury or nature of illness
 Determine the number of patients and additional resources
EMERGENCY ACTION PRINCIPLES
Activate medical assistance (AMA) or transfer facility

In some emergency, you will have enough time to call for specific medical
advice before administering first aid. But in some situations, you will need
to attend to the victim first.
Phone First and Phone Fast

Both trained and untrained bystanders should be instructed to Activate
Medical Assistance as soon as they have determined that an adult victim
requires emergency care ―Phone First‖. While for infants and children a
―Phone Fast‖ approach is recommended.
DO A PRIMARY SURVEY OF THE VICTIM

In every emergency situation, you must first find out if there are conditions
that are an immediate threat to the victim‘s life.
 Check for Consciousness

 Check for Breathing
 Check for Airway
 Check for Circulation
DO A SECONDARY SURVEY
It is a systematic method of gathering additional information about injuries
or conditions that may need care.
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1. Interview the victim

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COMMON COMPETENCY
3. Perform head-to-toe examination
GOLDEN RULES IN GIVING EMERGENCY CARE
What to DO:
 Do obtain consent, when possible
 Do think the worst. It‘s best to administer first aid for the gravest
possibility
 Do remember to identify yourself to the victim
 Do provide comfort and emotional support
 Do respect the victim‘s modesty and physical privacy.
 Do be as calm and as direct as possible.
 Do care for the most serious injuries first.
 Do assist the victim with his or her prescription medication
 Do keep onlookers away from the injured person
 Do handle the victim to a minimum
 Do loosen tight clothing
What not to DO:

 Do not let the victim see his/her own injury.
 Do not leave the victim alone except to get help.
 Do not assume that the victim‘s obvious injuries are the only ones.
 Do not make any unrealistic promises.
 Do not trust the judgment of a confused victim and require them to
make decision.
SOURCE
https://www.slideshare.net/davejaymanriquez/module-1-guidelines-in-
giving-emergency-care
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SELF CHECK 3.2-4
1. The following are the things that you need to do in giving emergency care
except
a. remember to identify yourself to the victim
b. provide comfort and emotional support
c. respect the victim‘s modesty and physical privacy
d. leave the victim alone except to get help
2. What do you do when you make primary survey of the victim

a. Check for Consciousness
b. Check for Breathing
c. Check for Airway
d. Check for Circulation
e. All of the above
3. Following are the emergency care guidelines except..

a. Plan of action
b. Gathering of needed materials
c. Initial response
d. Ask for help
e. Instruction to helper/s
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ANSWER KEY 3.2-4
1. The following are the things that you need to do in giving emergency care
except
a. remember to identify yourself to the victim
b. provide comfort and emotional support
c. respect the victim‘s modesty and physical privacy
d. leave the victim alone except to get help
2. What do you do when you make primary survey of the victim

a. Check for Consciousness
b. Check for Breathing
c. Check for Airway
d. Check for Circulation
e. All of the above
3. Following are the emergency care guidelines except..

a. Plan of action
b. Gathering of needed materials
c. Initial response
d. Ask for help
e. Instruction to helper/s
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“BASIC LIFE SUPPORT”
INTRODUCTION
Basic life support (BLS) includes recognition of signs of sudden cardiac

arrest, heart attack, stroke, and foreign body airway obstruction, and the
performance of cardiopulmonary resuscitation (CPR) and defibrillation with
an automated external defibrillator.
Knowledge of BLS and practice of simple CPR techniques increase the

chances of survival of the patient until experienced medical help arrives
and, in most cases, is sufficient for survival in itself. It is important that
those who may be present at the scene of a cardiac arrest particularly lay
bystanders, have knowledge of appropriate resuscitation skills and the
ability to put these into practice. Even if they have poor initial knowledge,
medical students are able to transfer CPR skills to others after they have
been taught. Therefore, it is crucial that everyone in the medical field has
knowledge of BLS.
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Level of Responsiveness
Determine the patient‘s level of responsiveness (LOR) by gently tapping the
patient on the shoulder and asking, ―Are you okay?‖
Open the Airway

To open and assess an unresponsive patient‘s airway, perform a head-tilt/
chin-lift:
1. Place two fingers under the patient‘s mandible (jaw).
2. Place the palm of your other hand on the patient‘s forehead.
3. Tilt the patient‘s head back while lifting the chin.
This motion will reposition the tongue so that it does not block the airway.
If the patient has a suspected head and/or spinal injury, perform a jaw
thrust:
1. Kneel or stand behind the patient‘s head.
2. Place both palms on the patient‘s cheekbones.
3. Place two fingers of each hand under the patient‘s mandible and
pull forward.
If the jaw thrust is unsuccessful, do a head-tilt/chin-lift, keeping the neck

in line with the body.
Check Breathing and Circulation

Simultaneously check the patient‘s breathing and circulation (carotid pulse)
(Table 2–1) for no longer than 10 seconds. If no pulse is detected after a
maximum of 10 seconds, initiate CPR/AED.
Agonal Respirations
Agonal respirations are an inadequate and irregular pattern of breathing
sometimes associated with cardiac arrest. If a patient indicates agonal
respirations, he or she is not breathing normally.
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COMMON COMPETENCY
Any patient who is unresponsive and does not have a pulse requires CPR
(Table 2–2).
CPR Chest Compressions
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Minimize CPR Interruptions
Chest compression fraction is the measurement of the amount of time that
compressions are being performed. A chest compression fraction time of
around 80% is the aim, with a minimum of around 60%.
Resuscitation Mask
A resuscitation mask (or pocket mask) is used for direct ventilations (Figure
2–2 and 2–3, a–b). It also acts as personal protective equipment (PPE),
providing a barrier between you and the patient during resuscitation.
Bag-Valve-Mask
A bag-valve-mask (BVM) is used for a patient in respiratory arrest or a
patient whose respiratory rate is too low or too high. A BVM is best used by
two responders (Figure 2–4 and Figure 2–5). To properly use a BVM, you
must attach it to an oxygen reservoir bag. If you are using a BVM without a
partner (Figure 2–6), you must maintain the mask seal with one hand,
monitor the airway, and simultaneously provide ventilations with your other
hand.
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CHILDREN AND INFANTS
Some BVMs are designed specifically for children and infants. These BVMs
also include a valve that prevents over inflation of the lungs.
Defibrillators
The automated external defibrillator (AED) is the most common defibrillator,
but there are many others that vary slightly in use. It is important that you
know and follow the manufacturer‘s instructions for proper use and
maintenance of your particular defibrillator. Use a defibrillator in
combination with CPR for patients in cardiac arrest. If two responders are
present, one should begin CPR while the second prepares the defibrillator
and applies the pads to the patient. Activate the defibrillator immediately to
allow the device to begin analyzing the patient as soon as possible.
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1. Expose and prepare the patient‘s chest.

2. Attach the pads to the patient‘s chest as directed by the defibrillator‘s
manufacturer.
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COMMON COMPETENCY
• Typically, one pad is placed on the upper right side of the chest and
the other on the lower left side with 2.5 cm (1 in.) of space between them.
3. Pause CPR to allow the defibrillator to analyze the patient‘s heart rhythm.
Do not touch the patient or the defibrillator during this time. The
defibrillator will notify you when the analysis is complete. Follow the
defibrillator‘s prompts.
4. Continue chest compressions while the defibrillator charges in
preparation to deliver a shock.
5. Resume CPR, follow the defibrillator‘s prompts, and reanalyze after 5 CPR
cycles.
6. If the defibrillator advises a shock and then later advises no shock, the
patient‘s condition has changed. Quickly reassess the patient‘s circulation
before proceeding.
There are two types of airway obstruction:

1. Anatomical airway obstruction
2. Foreign-body airway obstruction
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Anatomical airway obstructions occur when the airway is blocked by an

anatomical structure (e.g., the tongue or swollen tissues of the mouth and
throat).
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Foreign-body airway obstructions (FBAO) occur when the airway is blocked
by a foreign object (e.g., a piece of food) or by fluids (e.g., vomit). This may
also be referred to as a mechanical obstruction.
An airway obstruction can be either partial or complete.
Partial airway obstruction:

• The patient can breathe but has difficulty (e.g., wheezing).
• Have the patient cough forcefully. If possible, have the patient sit
down and lean forward.
• Partial choking can quickly escalate to complete choking; monitor
the patient closely.
Complete airway obstruction:

• The patient cannot speak, breathe, or cough effectively.
• The patient may be able to cough weakly or make high-pitched
noises.
• Immediate intervention is required.
The interventions for both responsive and unresponsive patients with

complete airway obstructions are primarily effective, but these interventions
should be attempted even if you are unsure whether the obstruction is
anatomical or mechanical.
Responsive Adult or Child

Alternate between at least two of the following three methods for clearing a
responsive adult or child are back blows, abdominal thrusts, and chest
thrusts (Figure 2–7 and Figure 2–8). Choose the method most suitable for
the patient.
Regardless of the combination of methods you choose, continue

interventions until one of the following occurs:
• The foreign body is dislodged.
• The patient begins to breathe or cough.
• The patient becomes unresponsive.
If the patient becomes unresponsive and collapses, begin treatment for an

unresponsive patient (page 18).
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BACK BLOWS
1. Assume a stable stance behind the patient.

 Wrap one arm around the patient‘s chest and bend the patient
forward at the waist until the upper airway is at least parallel to the
ground.
2. With the heel of your other hand, deliver 5 firm blows between the
shoulder blades, checking after each blow to see if the obstruction has
cleared.
ABDOMINAL THRUSTS
1. Assume a stable stance behind the patient.

2. Make a fist and place it thumb side-in against the patient‘s abdomen, just
above the navel and well below the lower tip of the sternum (breastbone).
3. Grasp your fist with your other hand and give up to 5 quick upward
thrusts into the abdomen, checking after each thrust to see if the
obstruction has been cleared.
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SOURCE
https://www.alertfirstaid.com/pdf/coursepdf/BLS%20Basic%20Life%20Su
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pport%20Field%20Guide_149.pdf
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COMMON COMPETENCY
SELF CHECK 3.2-5
1. What is the compression to ventilation ratio you should use when giving
CPR to any individual?
a. 30:1
b. 30:2
c. 15:1
d. 15:2
2. When performing two-rescuer CPR, how often should you switch roles?
a. After every cycle of CPR
b. After every two cycles of CPR
c. After every five cycles of CPR
d. After every 10 cycles of CPR
3. When operating an AED, what are the correct steps to follow?

a. Power on the AED, attach electrode pads, shock the individual, and
analyze the rhythm
b. Power on the AED, attach electode pads, analyze the rhythm, clear the
individual, and deliver shock
c. Attach electrode pads, check pulse, shock individual, and analyze
rhythm
d. Check pulse, attach electrode pads, analyze rhythm, shock patient
4. When looking for a pulse on a child from one year to puberty, where
should you check?
a. Brachial artery
b. Ulnar artery
c. Temporal artery
d. Carotid or femoral artery
5. What are the BLS (Basic Life Support) steps used for adults?
a. Assess the individual, give two rescue breaths, defibrillate, and start
CPR
b. Assess the individual, activate EMS and get AED, check pulse, and
start CPR
c. Check pulse, give rescue breaths, assess the individual, and
defibrillate
d. Assess the individual, start CPR, give two rescue breaths, and
defibrillate
6. What are the vital characteristics of first-rate CPR?

a. Starting chest compressions within 10 seconds of recognition of
cardiac arrest
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b. Pushing hard and fast

c. Minimizing interruptions
d. All of the above
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7. Which step is NOT a part of the five steps in the Adult Chain of Survival?
a. Early CPR
b. Rapid defibrillation
c. Advanced airway placement
d. Integrated post-cardiac arrest care
8. What is the recommended BLS sequence?

a. Chest compressions, Airway, Breathing
b. None of the above
c. Airway, Breathing, Check pulse
d. Airway, Breathing, Chest compressions
9. What are the signs of an obstruction of the airway?

a. Poor air exchange
b. High-pitched noise while inhaling
c. Inability to speak
d. All of the above
10. How many breaths should be given during a two-rescuer CPR on an

adult with an advanced airway in place?
a. Every 2 to 3 seconds (20 to 30 breaths per minute)
b. Every 4 to 5 seconds (12 to 15 breaths per minute)
c. Every 6 to 8 seconds (8 to 10 breaths per minute)
d. Every 10 to 12 seconds (5 to 6 breaths per minute)
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COMMON COMPETENCY
ANSWER KEY 3.2-5
1. B
2. C
3. B
4. D
5. B
6. D
7. C
8. A
9. D
10. C
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“DETAILED HISTORY OF CASUALTY”
INTRODUCTION
The questions that are asked to the patient include Signs & Symptoms,
Allergies, Medications, Past medical history, Last oral intake, and Events
leading up to present injury (SAMPLE). SAMPLE history is an mnemonic
acronym to remember key questions for a person's medical assessment.
S – Signs and Symptoms – By asking the question ―What seems to be

bothering you?‖ a rescuer can get the answers from his or her victim.
A – Allergies – Allergies play a significant role in first aid emergencies.

Rescuers can ask ―Do you have any allergies I should know about?‖ to
determine the answer to this question. More advanced rescuers can ask
questions pertaining to medical allergies.
M – Medication – A victim forgetting to take his or her medication or a

victim that carries a certain type of medication (ex: Nitro for Heart Attacks),
can help a rescuer determine the problem. A simple question of ―Are you on
any medication?‖ can help a rescuer obtain the information from the victim.
P – Past Pertinent History – This part of the acronym, usually confused

with the E (which you‘ll find out about soon), is associated with finding out
whether this has happened to the victim in the past. If these symptoms are
re-occuring the victim can help by telling what the cause was in the
previous circumstance. A simple question of ―Has this happened to you
before?‖ can aid in retrieving this information from the victim.
L – Last Meal – Past meal time can help in determine if the victim might be
suffering from a number of issues, with a likely scenario being low blood
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sugar. In this circumstance the victim might need to increase blood sugar. A
good question to ask would be ―When was your last meal‖ or ―Did you have
breakfast/lunch/dinner?‖
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COMMON COMPETENCY
E – Events Prior to – Not to be confused with past pertinent history, this
final letter in the acronym is associated with what the victim was doing prior
to the first aid emergency. An example of the how this part of the acronym
apply‘s can be in the role of excessive exercise to a an ―out-of-shape‖ victim
which can have a number of effects. A good question in this circumstance is
―What were you doing before this happened?‖
Plus DO NOT FORGET THE ―LOCPRESS‖ is an acronym used after the

primary survey, history check and the head-to-toe have been completed in
order to receive more information about the victims condition and to
uncover any new injuries or conditions. During this portion fo the secondary
survey, the rescuer(s) will monitor the vital signs of the victim periodically
(every 5 to 10 minutes) while treating any discovered injuries. Rescuers will
be on alret for sounds, odours, colores, rates and rhythms and temperature
shifts. The five vital signs that rescuers will be monitoring is level of
consciousness, breathing, pulse, skin temperature, and pupils. A good
method of remembering the vitals to monitor is by using an acronym called
―LOCPRESS‖.
“LOCPRESS” stands for:

 LOC – Level of Consciousness
 P – Pulse
 R – Respiration
 E – Eyes
 S – Skin Color
 S – Skin Temperature
Plus in your patient review did you PASTE the patient
The signs and symptoms assessment is very important, especially during

171
respiratory emergencies, but they are objective. So ―PASTE‖ can be used by

the rescuer to gather relevant information about the patient‘s health. This is
an alternate mnemonic for evaluating a patient having difficulty in
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COMMON COMPETENCY
PASTE stands for:
 Provoke: Find out whether any external factor such as movement is
making the situation better or worse.
 Associated Chest Pain: This will elicit descriptions of the patient‘s

pain in and around chest area.
 Sputum production (color): Is the patient coughing up sputum.

Mucus-like sputum can be an indication of infection or any problem
in respiratory system.
 Talking & Tiredness: Is the patient talking with you? Is he/she

feeling tired? If the patient is not talking or responding to your voice,
perform CPR immediately.
 Exacerbation: Check whether the condition of the patient is

worsening with time.
And as you move forward with monitors in your patient do they have DOTS
DOTS is an acronym used to remember what to look for when conducting a

physical assessment of a casualty (ie, looking for injuries).
DOTS stands for:

 Deformities.
 Open wounds.
 Tenderness.
Major depressive episode

A major depressive episode includes symptoms that are severe enough to
cause noticeable difficulty in day-to-day activities, such as work, school,
social activities or relationships. An episode includes five or more of these
symptoms:
 Depressed mood, such as feeling sad, empty, hopeless or tearful (in

children and teens, depressed mood can appear as irritability)
 Marked loss of interest or feeling no pleasure in all — or almost all —
activities
 Significant weight loss when not dieting, weight gain, or decrease or
increase in appetite (in children, failure to gain weight as expected can
be a sign of depression)
 Either insomnia or sleeping too much
 Either restlessness or slowed behavior
 Fatigue or loss of energy
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 Feelings of worthlessness or excessive or inappropriate guilt

 Decreased ability to think or concentrate, or indecisiveness
 Thinking about, planning or attempting suicide
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Allergies
An allergy is an immune system response to a foreign substance that‘s not
typically harmful to your body. These foreign substances are called
allergens. They can include certain foods, pollen, or pet dander.
Your immune system‘s job is to keep you healthy by fighting harmful

pathogens. It does this by attacking anything it thinks could put your body
in danger. Depending on the allergen, this response may involve
inflammation, sneezing, or a host of other symptoms.
Your immune system normally adjusts to your environment. For example,

when your body encounters something like pet dander, it should realize it‘s
harmless. In people with dander allergies, the immune system perceives it
as an outside invader threatening the body and attacks it.
Allergies are common. Several treatments can help you avoid your
symptoms.
Symptoms of allergies
The symptoms you experience because of allergies are the result of several
factors. These include the type of allergy you have and how severe the
allergy is.
If you take any medication before an anticipated allergic response, you may
still experience some of these symptoms, but they may be reduced.
For food allergies

Food allergies can trigger swelling, hives, nausea, fatigue, and more. It may
take a while for a person to realize that they have a food allergy. If you have
a serious reaction after a meal and you‘re not sure why, see a medical
professional immediately. They can find the exact cause of your reaction or
refer you to a specialist.
For seasonal allergies

Hay fever symptoms can mimic those of a cold. They include congestion,
runny nose, and swollen eyes. Most of the time, you can manage these
symptoms at home using over-the-counter treatments. See your doctor if
your symptoms become unmanageable.
For severe allergies

Severe allergies can cause anaphylaxis. This is a life-threatening emergency
that can lead to breathing difficulties, lightheadedness, and loss of
consciousness. If you‘re experiencing these symptoms after coming in
contact with a possible allergen, seek medical help immediately.
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Everyone‘s signs and symptoms of an allergic reaction are different. Read

more about allergy symptoms and what might cause them.
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COMMON COMPETENCY
Allergies on skin
Skin allergies may be a sign or symptom of an allergy. They may also be the
direct result of exposure to an allergen.
For example, eating a food you‘re allergic to can cause several symptoms.
You may experience tingling in your mouth and throat. You may also
develop a rash.
Contact dermatitis, however, is the result of your skin coming into direct
contact with an allergen. This could happen if you touch something you‘re
allergic to, such as a cleaning product or plant.
Types of skin allergies include:

 Rashes. Areas of skin are irritated, red, or swollen, and can be painful
or itchy.
 Eczema. Patches of skin become inflamed and can itch and bleed.
 Contact dermatitis. Red, itchy patches of skin develop almost
immediately after contact with an allergen.
 Sore throat. Pharynx or throat is irritated or inflamed.
 Hives. Red, itchy, and raised welts of various sizes and shapes
develop on the surface of the skin.
 Swollen eyes. Eyes may be watery or itchy and look ―puffy.‖
 Itching. There‘s irritation or inflammation in the skin.
 Burning. Skin inflammation leads to discomfort and stinging
sensations on the skin.
SOURCE
https://www.healthline.com/health/allergies#skin-allergies
https://www.mayoclinic.org/diseases-conditions/bipolar-
disorder/symptoms-causes/syc-20355955
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SELF CHECK 3.3-1
1. Areas of skin are irritated, red, or swollen, and can be painful or itchy.
a. Rashes
b. Eczema
c. Sore throat
d. Hives
2. There‘s irritation or inflammation in the skin.

a. Swollen eyes
b. Itching
c. Burning
d. Hives
3. An immune system response to a foreign substance that‘s not typically

harmful to your body.
a. Swollen eyes
b. Itching
c. Burning
d. Allergies
4. SAMPLE stands for

a. Sign and Symptoms, Allergies, Medications, Pertinent Past History,
Last Intake, Events leading up to Injury
b. Sore Throat, Allergies, Medical, Pertinent Past History, Last Intake,
Events leading up to Injury
c. Sign and Symptoms, Allergies, Medications, Pertinent Past History,
Last Intake, Events leading up to Injury
d. Sign and Symptoms, Allergies, Medical, Pertinent Past History, Last
Intake, Events leading up to Injury
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ANSWER KEY 3.3-1
1. A
2. B
3. D
4. A
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“PHYSICAL EXAMINATION”
INTRODUCTION
A physical examination is a routine test your Primary Care Provider (PCP)

performs to check your overall health. A PCP may be a doctor, a nurse
practitioner, or a physician assistant. The exam is also known as a wellness
check. You don‘t have to be sick to request an exam.
The physical exam can be a good time to ask your PCP questions about your
health or discuss any changes or problems that you have noticed.
There are different tests that can be performed during your physical
examination. Depending on your age or medical or family history, your PCP
may recommend additional testing.
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Begin care and assessment in the order of importance:
Airway
What is an airway obstruction?
An airway obstruction is a blockage in any part of the airway. The airway is

a complex system of tubes that conveys inhaled air from your nose and
mouth into your lungs. An obstruction may partially or totally prevent air
from getting into your lungs.
Some airway obstructions are minor, while others are life-threatening

emergencies that require immediate medical attention.
Types of airway obstructions

The types of airway obstructions are classified based on where the
obstruction occurs and how much it blocks:
 Upper airway obstructions occur in the area from your nose and lips
to your larynx (voice box).
 Lower airway obstructions occur between your larynx and the narrow
passageways of your lungs.
 Partial airway obstructions allow some air to pass. You can still
breathe with a partial airway obstruction, but it‘s difficult.
 Complete airway obstructions don‘t allow any air to pass. You can‘t
breathe if you have a complete airway obstruction.
 Acute airway obstructions are blockages that occur quickly. Choking
on a foreign object is an example of an acute airway obstruction.
 Chronic airway obstructions occur two ways: by blockages that take a
long time to develop or by blockages that last for a long time.
What causes an airway obstruction?

The classic image of an airway obstruction is someone choking on a piece of
food. But that‘s only one of many things that can cause an airway
obstruction.
Other causes include:

 inhaling or swallowing a foreign object
 small object lodged in the nose or mouth
 allergic reaction
 trauma to the airway from an accident
 vocal cord problems
 breathing in a large amount of smoke from a fire
 viral infections
 bacterial infections
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 respiratory illness that causes upper airway inflammation (croup)

 swelling of the tongue or epiglottis
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 abscesses in the throat or tonsils

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 collapse of the tracheal wall (tracheomalacia)
 asthma
 chronic bronchitis
 emphysema
 cystic fibrosis
 chronic obstructive pulmonary disease (COPD)
Breathing
The process of respiration, during which air is inhaled into the lungs
through the mouth or nose due to muscle contraction and then exhaled due
to muscle relaxation.
What Is the Respiratory System?

The respiratory system is the organs and other parts of your body involved
in breathing, when you exchange oxygen and carbon dioxide.
Parts of the Respiratory System
Your respiratory system includes your:

 Nose and nasal cavity
 Sinuses
 Mouth
 Throat (pharynx)
 Voice box (larynx)
 Windpipe (trachea)
 Diaphragm
 Lungs
 Bronchial tubes/bronchi
 Bronchioles
 Air sacs (alveoli)
 Capillaries
How Do We Breathe?
Breathing starts when you inhale air into your nose or mouth. It travels
down the back of your throat and into your windpipe, which is divided into
air passages called bronchial tubes.
For your lungs to perform their best, these airways need to be open. They
should be free from inflammation or swelling and extra mucus.
As the bronchial tubes pass through your lungs, they divide into smaller air
passages called bronchioles. The bronchioles end in tiny balloon-like air
sacs called alveoli. Your body has about 600 million alveoli.
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The alveoli are surrounded by a mesh of tiny blood vessels called capillaries.
Here, oxygen from inhaled air passes into your blood.
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After absorbing oxygen, blood goes to your heart. Your heart then pumps it
through your body to the cells of your tissues and organs.
As the cells use the oxygen, they make carbon dioxide that goes into your
blood. Your blood then carries the carbon dioxide back to your lungs, where
it‘s removed from your body when you exhale.
Inhalation and Exhalation

Inhalation and exhalation are how your body brings in oxygen and gets rid
of carbon dioxide. The process gets help from a large dome-shaped muscle
under your lungs called the diaphragm.
When you breathe in, your diaphragm pulls downward, creating a vacuum
that causes a rush of air into your lungs.
The opposite happens with exhalation: Your diaphragm relaxes upward,

pushing on your lungs, allowing them to deflate.
Circulation
he circulatory system is made up of blood vessels that carry blood away

from and towards the heart. Arteries carry blood away from the heart and
veins carry blood back to the heart. The circulatory system carries oxygen,
nutrients, and hormones to cells, and removes waste products, like carbon
dioxide.
Disabilities which includes mental status
 There are many different mental disorders, with different

presentations. They are generally characterized by a combination of
abnormal thoughts, perceptions, emotions, behaviour and
relationships with others.
 Mental disorders include: depression, bipolar disorder, schizophrenia
and other psychoses, dementia, and developmental disorders
including autism.
 There are effective strategies for preventing mental disorders such as
depression.
 There are effective treatments for mental disorders and ways to
alleviate the suffering caused by them.
 Access to health care and social services capable of providing
treatment and social support is key
Expose any body part that is fractured like extremities but

still maintain casualty’s privacy and dignity
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Techniques of physical examination
WHEN YOU PERFORM a physical assessment, you'll use four techniques:

inspection, palpation, percussion, and auscultation. Use them in
sequence—unless you're performing an abdominal assessment. Palpation
and percussion can alter bowel sounds, so you'd inspect, auscultate,
percuss, then palpate an abdomen.
1. Inspection
Inspect each body system using vision, smell, and hearing to assess normal
conditions and deviations. Assess for color, size, location, movement,
texture, symmetry, odors, and sounds as you assess each body system.
2. Palpation
Palpation requires you to touch the patient with different parts of your
hands, using varying degrees of pressure. Because your hands are your
tools, keep your fingernails short and your hands warm. Wear gloves when
palpating mucous membranes or areas in contact with body fluids. Palpate
tender areas last.
Types of palpation
Light palpation
 Use this technique to feel for surface abnormalities.

 Depress the skin ½ to ¾ inch (about 1 to 2 cm) with your finger pads,
using the lightest touch possible.
 Assess for texture, tenderness, temperature, moisture, elasticity,
pulsations, and masses.
Deep palpation
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 Use this technique to feel internal organs and masses for size, shape,
tenderness, symmetry, and mobility.
 Depress the skin 1½ to 2 inches (about 4 to 5 cm) with firm, deep
pressure.
 Use one hand on top of the other to exert firmer pressure, if needed.
3. Percussion
Percussion involves tapping your fingers or hands quickly and sharply
against parts of the patient's body to help you locate organ borders, identify
organ shape and position, and determine if an organ is solid or filled with
fluid or gas.
Types of percussion
Direct percussion
This technique reveals tenderness; it's commonly used to assess an adult's
sinuses.
 Using one or two fingers, tap directly on the body part.

 Ask the patient to tell you which areas are painful, and watch his face
for signs of discomfort.
Indirect percussion
This technique elicits sounds that give clues to the makeup of the
underlying tissue. Here's how to do it:
 Press the distal part of the middle finger of your non-dominant hand
firmly on the body part.
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 Keep the rest of your hands off the body surface.

 Flex the wrist of your non-dominant hand.
 Using the middle finger of your dominant hand, tap quickly and
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COMMON COMPETENCY
patient's skin.
 Listen to the sounds produced.
4. Auscultation
Auscultation involves listening for various lung, heart, and bowel sounds
with a stethoscope.
Getting ready
 Provide a quiet environment.
 Make sure the area to be auscultated is exposed (a gown or bed
linens can interfere with sounds.)
 Warm the stethoscope head in your hand.
 Close your eyes to help focus your attention.
How to auscultate
 Use the diaphragm to pick up high-pitched sounds, such as first (S1)
and second (S2) heart sounds. Hold the diaphragm firmly against the
patient's skin, using enough pressure to leave a slight ring on the
skin afterward.
 Use the bell to pick up low-pitched sounds, such as third (S3) and
fourth (S4) heart sounds. Hold the bell lightly against the patient's
skin, just hard enough to form a seal. Holding the bell too firmly
causes the skin to act as a diaphragm, obliterating low-pitched
sounds.
 Listen to and try to identify the characteristics of one sound at a time.
Examine the following:
DCAP-BTLS
An acronym that stands for deformities, contusions, abrasions,
penetrations or perforations, burns, tenderness, lacerations, and swelling;
to remember what is observed for when looking at soft tissue during the
assessment of a patient.
D - Deformity
C - Contusion
A - Abrasion
P - Punctured
B – Bleeding and burns
T – Tenderness
L - Laceration
S – Swelling
SOURCE
https://www.webmd.com/lung/how-we-breathe
https://journals.lww.com/nursing/Fulltext/2006/11002/Assessing_patient
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SELF CHECK 3.3-2
1. Involves tapping your fingers or hands quickly and sharply against parts
of the patient's body to help you locate organ borders, identify organ shape
and position, and determine if an organ is solid or filled with fluid or gas.
a. Percussion
b. Inspection
c. Palpation
d. Auscultation
2. It requires you to touch the patient with different parts of your hands,
using varying degrees of pressure.
a. Percussion
b. Inspection
c. Palpation
d. Auscultation
3. It involves listening for various lung, heart, and bowel sounds with a
stethoscope.
a. Percussion
b. Inspection
c. Palpation
d. Auscultation
4. It is the assessment of color, size, location, movement, texture, symmetry,

odors, and sounds as you assess each body system.
a. Percussion
b. Inspection
c. Palpation
d. Auscultation
5. This technique reveals tenderness; it's commonly used to assess an

adult's sinuses.
a. Percussion
b. Direct Percussion
c. Indirect Percussion
d. Auscultation
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ANSWER KEY 3.3-2
1. A
2. C
3. D
4. B
5. B
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“VITAL SIGNS”
INTRODUCTION
Vital signs are measurements of the body's most basic functions. The four
main vital signs routinely monitored by medical professionals and health
care providers include the following:
 Body temperature
 Pulse rate
 Respiration rate (rate of breathing)
 Blood pressure (Blood pressure is not considered a vital sign, but is

often measured along with the vital signs.)
Vital signs are useful in detecting or monitoring medical problems. Vital

signs can be measured in a medical setting, at home, at the site of a medical
emergency, or elsewhere.
What is body temperature?

The normal body temperature of a person varies depending on gender,
recent activity, food and fluid consumption, time of day, and, in women, the
stage of the menstrual cycle. Normal body temperature can range from 97.8
degrees F (or Fahrenheit, equivalent to 36.5 degrees C, or Celsius) to 99
degrees F (37.2 degrees C) for a healthy adult. A person's body temperature
can be taken in any of the following ways:
Orally. Temperature can be taken by mouth using either the classic glass
thermometer, or the more modern digital thermometers that use an
electronic probe to measure body temperature.
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Rectally. Temperatures taken rectally (using a glass or digital thermometer)

tend to be 0.5 to 0.7 degrees F higher than when taken by mouth.
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Axillary. Temperatures can be taken under the arm using a glass or digital
thermometer. Temperatures taken by this route tend to be 0.3 to 0.4 degrees
F lower than those temperatures taken by mouth.
By ear. A special thermometer can quickly measure the temperature of the

ear drum, which reflects the body's core temperature (the temperature of the
internal organs).
By skin. A special thermometer can quickly measure the temperature of the

skin on the forehead.
Body temperature may be abnormal due to fever (high temperature) or

hypothermia (low temperature). A fever is indicated when body temperature
rises about one degree or more over the normal temperature of 98.6 degrees
Fahrenheit, according to the American Academy of Family Physicians.
Hypothermia is defined as a drop in body temperature below 95 degrees
Fahrenheit.
About glass thermometers containing mercury
According to the Environmental Protection Agency, mercury is a toxic

substance that poses a threat to the health of humans, as well as to the
environment. Because of the risk of breaking, glass thermometers
containing mercury should be removed from use and disposed of properly in
accordance with local, state, and federal laws. Contact your local health
department, waste disposal authority, or fire department for information on
how to properly dispose of mercury thermometers.
What is the pulse rate?

The pulse rate is a measurement of the heart rate, or the number of times
the heart beats per minute. As the heart pushes blood through the arteries,
the arteries expand and contract with the flow of the blood. Taking a pulse
not only measures the heart rate, but also can indicate the following:
 Heart rhythm
 Strength of the pulse
The normal pulse for healthy adults ranges from 60 to 100 beats per
minute. The pulse rate may fluctuate and increase with exercise, illness,
injury, and emotions. Females ages 12 and older, in general, tend to have
faster heart rates than do males. Athletes, such as runners, who do a lot of
cardiovascular conditioning, may have heart rates near 40 beats per minute
and experience no problems.
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How to check your pulse
As the heart forces blood through the arteries, you feel the beats by firmly
pressing on the arteries, which are located close to the surface of the skin at
certain points of the body. The pulse can be found on the side of the neck,
on the inside of the elbow, or at the wrist. For most people, it is easiest to
take the pulse at the wrist. If you use the lower neck, be sure not to press
too hard, and never press on the pulses on both sides of the lower neck at
the same time to prevent blocking blood flow to the brain.
When taking your pulse:

 Using the first and second fingertips, press firmly but gently on the
arteries until you feel a pulse.
 Begin counting the pulse when the clock's second hand is on the 12.
 Count your pulse for 60 seconds (or for 15 seconds and then multiply
by four to calculate beats per minute).
 When counting, do not watch the clock continuously, but concentrate

on the beats of the pulse.
 If unsure about your results, ask another person to count for you.
If your doctor has ordered you to check your own pulse and you are having
difficulty finding it, consult your doctor or nurse for additional instruction.
What is the respiration rate?

The respiration rate is the number of breaths a person takes per minute.
The rate is usually measured when a person is at rest and simply involves
counting the number of breaths for one minute by counting how many times
the chest rises. Respiration rates may increase with fever, illness, and other
medical conditions. When checking respiration, it is important to also note
whether a person has any difficulty breathing.
Normal respiration rates for an adult person at rest range from 12 to 16

breaths per minute.
What is blood pressure?

Blood pressure is the force of the blood pushing against the artery walls
during contraction and relaxation of the heart. Each time the heart beats, it
pumps blood into the arteries, resulting in the highest blood pressure as the
heart contracts. When the heart relaxes, the blood pressure falls.
Two numbers are recorded when measuring blood pressure. The higher
number, or systolic pressure, refers to the pressure inside the artery when
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the heart contracts and pumps blood through the body. The lower number,
or diastolic pressure, refers to the pressure inside the artery when the heart
is at rest and is filling with blood. Both the systolic and diastolic pressures
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COMMON COMPETENCY
how high the mercury column in an old-fashioned manual blood pressure
device (called a mercury manometer or sphygmomanometer) is raised by the
pressure of the blood. Today, your doctor's office is more likely to use a
simple dial for this measurement.
High blood pressure, or hypertension, directly increases the risk of heart

attack, heart failure, and stroke. With high blood pressure, the arteries may
have an increased resistance against the flow of blood, causing the heart to
pump harder to circulate the blood.
Blood pressure is categorized as normal, elevated, or stage 1 or stage 2 high

blood pressure:
 Normal blood pressure is systolic of less than 120 and diastolic of less
than 80 (120/80)
 Elevated blood pressure is systolic of 120 to 129 and diastolic less

than 80
 Stage 1 high blood pressure is systolic is 130 to 139 or diastolic

between 80 to 89
 Stage 2 high blood pressure is when systolic is 140 or higher or the

diastolic is 90 or higher
These numbers should be used as a guide only. A single blood pressure

measurement that is higher than normal is not necessarily an indication of
a problem. Your doctor will want to see multiple blood pressure
measurements over several days or weeks before making a diagnosis of high
blood pressure and starting treatment. Ask your provider when to contact
him or her if your blood pressure readings are not within the normal range.
Why should I monitor my blood pressure at home?

For people with hypertension, home monitoring allows your doctor to
monitor how much your blood pressure changes during the day, and from
day to day. This may also help your doctor determine how effectively your
blood pressure medication is working.
What special equipment is needed to measure blood pressure?

Either an aneroid monitor, which has a dial gauge and is read by looking at
a pointer, or a digital monitor, in which the blood pressure reading flashes
on a small screen, can be used to measure blood pressure.
About the aneroid monitor

The aneroid monitor is less expensive than the digital monitor. The cuff is
inflated by hand by squeezing a rubber bulb. Some units even have a special
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feature to make it easier to put the cuff on with one hand. However, the unit
can be easily damaged and become less accurate. Because the person using
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it must listen for heartbeats with the stethoscope, it may not be appropriate
for the hearing-impaired.
About the digital monitor

The digital monitor is automatic, with the measurements appearing on a
small screen. Because the recordings are easy to read, this is the most
popular blood pressure measuring device. It is also easier to use than the
aneroid unit, and since there is no need to listen to heartbeats through the
stethoscope, this is a good device for hearing-impaired patients. One
disadvantage is that body movement or an irregular heart rate can change
the accuracy. These units are also more expensive than the aneroid
monitors.
About finger and wrist blood pressure monitors

Tests have shown that finger and/or wrist blood pressure devices are not as
accurate in measuring blood pressure as other types of monitors. In
addition, they are more expensive than other monitors.
Before you measure your blood pressure:

The American Heart Association recommends the following guidelines for
home blood pressure monitoring:
 Don't smoke or drink coffee for 30 minutes before taking your blood
pressure.
 Go to the bathroom before the test.
 Relax for 5 minutes before taking the measurement.
 Sit with your back supported (don't sit on a couch or soft chair). Keep
your feet on the floor uncrossed. Place your arm on a solid flat surface
(like a table) with the upper part of the arm at heart level. Place the
middle of the cuff directly above the bend of the elbow. Check the
monitor's instruction manual for an illustration.
 Take multiple readings. When you measure, take 2 to 3 readings one

minute apart and record all the results.
 Take your blood pressure at the same time every day, or as your
healthcare provider recommends.
 Record the date, time, and blood pressure reading.
 Take the record with you to your next medical appointment. If your
blood pressure monitor has a built-in memory, simply take the
monitor with you to your next appointment.
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 Call your provider if you have several high readings. Don't be
frightened by a single high blood pressure reading, but if you get
several high readings, check in with your healthcare provider.
 When blood pressure reaches a systolic (top number) of 180 or higher

OR diastolic (bottom number) of 110 or higher, seek emergency
medical treatment.
Ask your doctor or another healthcare professional to teach you how to use
your blood pressure monitor correctly. Have the monitor routinely checked
for accuracy by taking it with you to your doctor's office. It is also important
to make sure the tubing is not twisted when you store it and keep it away
from heat to prevent cracks and leaks.
Proper use of your blood pressure monitor will help you and your doctor in
monitoring your blood pressure.
SOURCE
https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-
signs-body-temperature-pulse-rate-respiration-rate-blood-pressure
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SELF CHECK 3.3-3
1. Vital signs includes, blood pressure, Pulse, Temp. Resp. rate & Oxygen
saturation
a. True
b. False
2. Where is temperature is regulated?

a. Hypothalamus
b. Skin
c. Heat & Cold
d. By what a person wear
3. What is the normal range of temperature?

a. 34-36 c
b. 34.6-36 c
c. 35.6-38 c
d. 36.6-37.5 c
4. What is the normal pulse rate?

a. 12-20
b. 15-20
c. 60-100
d. 50-80
5. A weak pulse is rated as

a. 0
b. 1+
c. 2+
d. 3+
e. 4+
6. A patient have a pulse rate of 102, resp. rate of 25, a B/P of 139/90 and
a temp. of 103 F. As a nurse which will you assess first?
a. B/P of 139/90
b. Pulse of 102
c. Resp. rate of 25
d. Temp. of 103 F
7. Blood pressure is the force against the aterial wall

a. True
b. False
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COMMON COMPETENCY
ANSWER KEY 3.3-3
1. A
2. A
3. D
4. C
5. C
6. D
7. A
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“WRITTEN INCIDENT REPORT”
INTRODUCTION
An incident report is a formal recording of the facts related to a workplace

accident, injury, or near miss. Its primary purpose is to uncover the
circumstances and conditions that led to the event in order to prevent future
incidents.
Every incident report you file should contain a minimum of the following:
 Type of incident (injury, near miss, property damage, or theft)
 Address
 Date of incident
 Time of incident
 Name of affected individual
 A narrative description of the incident, including the sequence of
events and results of the incident
 Injuries, if any
 Treatments required, if any
 Witness name(s)
 Witness statements
 Other workers involved
 Video and/or 360-degree photographs of the scene
Include quantifiable measurements where possible. For example, the ladder

capacity is 250 lbs and the victim was hoisting 300 lbs.
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Finally, where more than one person is injured in an incident, create a

unique report for each affected employee. While it‘s fine to duplicate general
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details between reports of this nature, you‘ll need to include details specific
to that person, such as the event from their point of view or medical records.
When Does an Incident Report Need to Be Completed?

Create an incident report as soon as your employees are safe, which
includes seeking medical attention and implementing an immediate
corrective action to prevent further danger or damage.
By recording details immediately, you improve the accuracy of your report

and the effects of your corrective actions. While it may take a few days to
complete your report, it should take you only hours (or less) to start it.
Three Incident Report Samples

Below are some sample incident report formats for three common types of
workplace accidents. Use them as guides to effectively describe events.
Injury and Lost Time Incident Report Sample

If an injury requiring medical treatment, lost time/altered responsibilities
happens in your workplace, it‘s important to document it ASAP while the
details are still fresh in memory.
Here are some of the vital elements to include in your description of the
incident:
 Type of incident (injury, near miss, property damage, or theft)
 Location (Address)
 Date/time of incident
 Name
 Name of supervisor
 Description of the incident, including specific job site location, the
sequence of events, and the results of the event
 Whether or not proper PPE was being used
 The root cause(s) of the incident
 Associated hazards raised and resolved following the event
 The affected individual‘s version of the events
 Actions taken by concerned individuals after the incident
 Description of injuries
 How the decision was made to call (or not to call) emergency services
 Treatment required
 Witness name(s)
 Witness statements
 Photographs of the scene
Though the details above seem excessive, mentioning them in the incident
report paints a more accurate picture. It‘s important to include the above
information in as detailed and concise a manner as possible. Holes in your
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report could lead to inferences and missed opportunities to create a safer

workplace.
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SELF CHECK 3.3-4
1. Which of the following is the primary reason for accident investigation?

a. To identify a scapegoat
b. To find fault
c. To take disciplinary action
d. To prevent future accidents
2. What is the purpose of an accident investigation?

a. To identify who could be blamed
b. To collect facts
c. To find fault
d. All of the above
3. Select the correct sequence of steps in the accident investigation.

a. Identify witnesses, isolate the accident site, record all evidence,
photograph or videotape the scene, interview witnesses.
b. Photograph or videotape the scene, identify witnesses, interview
witnesses, record all evidence, isolate the accident site.
c. Isolate the accident site, record all evidence, photograph or videotape
the scene, identify witnesses, interview witnesses.
d. None of the above.
4. When interviewing witnesses, what questions should be asked?

a. How and why
b. Where and when
c. What and who
d. All of the above
5. Injuries/illnesses must be recorded if they result in:

a. Death
b. One or more lost workdays
c. Restriction of motion or work
d. All of the above
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ANSWER KEY 3.3-4
1. D
2. B
3. C
4. D
5. D
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HCS323204
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“EFFECTIVE COMMUNICATION”
INTRODUCTION
Want to communicate better? These tips will help you avoid

misunderstandings, grasp the real meaning of what‘s being communicated,
and greatly improve your work and personal relationships.
Effective communication is about more than just exchanging information.

It‘s about understanding the emotion and intentions behind the information.
As well as being able to clearly convey a message, you need to also listen in
a way that gains the full meaning of what‘s being said and makes the other
person feel heard and understood.
Effective communication sounds like it should be instinctive. But all too

often, when we try to communicate with others something goes astray. We
say one thing, the other person hears something else, and
misunderstandings, frustration, and conflicts ensue. This can cause
problems in your home, school, and work relationships.
For many of us, communicating more clearly and effectively requires

learning some important skills. Whether you‘re trying to improve
communication with your spouse, kids, boss, or coworkers, learning these
skills can deepen your connections to others, build greater trust and
respect, and improve teamwork, problem solving, and your overall social and
emotional health.
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What’s stopping you from communicating effectively?
Common barriers to effective communication include:
Stress and out-of-control emotion. When you‘re stressed or emotionally

overwhelmed, you‘re more likely to misread other people, send confusing or
off-putting nonverbal signals, and lapse into unhealthy knee-jerk patterns of
behavior. To avoid conflict and misunderstandings, you can learn how to
quickly calm down before continuing a conversation.
Lack of focus. You can‘t communicate effectively when you‘re multitasking.

If you‘re checking your phone, planning what you‘re going to say next, or
daydreaming, you‘re almost certain to miss nonverbal cues in the
conversation. To communicate effectively, you need to avoid distractions and
stay focused.
Inconsistent body language. Nonverbal communication should reinforce

what is being said, not contradict it. If you say one thing, but your body
language says something else, your listener will likely feel that you‘re being
dishonest. For example, you can‘t say ―yes‖ while shaking your head no.
Negative body language. If you disagree with or dislike what‘s being said,
you might use negative body language to rebuff the other person‘s message,
such as crossing your arms, avoiding eye contact, or tapping your feet. You
don‘t have to agree with, or even like what‘s being said, but to communicate
effectively and not put the other person on the defensive, it‘s important to
avoid sending negative signals.
Effective Communication Skill: Become an engaged listener
When communicating with others, we often focus on what we should say.

However, effective communication is less about talking and more about
listening. Listening well means not just understanding the words or the
information being communicated, but also understanding the emotions the
speaker is trying to convey.
There‘s a big difference between engaged listening and simply hearing. When
you really listen—when you‘re engaged with what‘s being said—you‘ll hear
the subtle intonations in someone‘s voice that tell you how that person is
feeling and the emotions they‘re trying to communicate. When you‘re an
engaged listener, not only will you better understand the other person, you‘ll
also make that person feel heard and understood, which can help build a
stronger, deeper connection between you.
By communicating in this way, you‘ll also experience a process that lowers

stress and supports physical and emotional well-being. If the person you‘re
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talking to is calm, for example, listening in an engaged way will help to calm
you, too. Similarly, if the person is agitated, you can help calm them by
listening in an attentive way and making the person feel understood.
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If your goal is to fully understand and connect with the other person,
listening in an engaged way will often come naturally. If it doesn‘t, try the
following tips. The more you practice them, the more satisfying and
rewarding your interactions with others will become.
Tips for becoming an engaged listener
Focus fully on the speaker. You can‘t listen in an engaged way if you‘re
constantly checking your phone or thinking about something else. You need
to stay focused on the moment-to-moment experience in order to pick up
the subtle nuances and important nonverbal cues in a conversation. If you
find it hard to concentrate on some speakers, try repeating their words over
in your head—it‘ll reinforce their message and help you stay focused.
Favor your right ear. As strange as it sounds, the left side of the brain
contains the primary processing centers for both speech comprehension and
emotions. Since the left side of the brain is connected to the right side of the
body, favoring your right ear can help you better detect the emotional
nuances of what someone is saying.
Avoid interrupting or trying to redirect the conversation to your

concerns. By saying something like, ―If you think that‘s bad, let me tell you
what happened to me.‖ Listening is not the same as waiting for your turn to
talk. You can‘t concentrate on what someone‘s saying if you‘re forming what
you‘re going to say next. Often, the speaker can read your facial expressions
and know that your mind‘s elsewhere.
Show your interest in what’s being said. Nod occasionally, smile at the
person, and make sure your posture is open and inviting. Encourage the
speaker to continue with small verbal comments like ―yes‖ or ―uh huh.‖
Try to set aside judgment. In order to communicate effectively with

someone, you don‘t have to like them or agree with their ideas, values, or
opinions. However, you do need to set aside your judgment and withhold
blame and criticism in order to fully understand them. The most difficult
communication, when successfully executed, can often lead to an unlikely
connection with someone.
Provide feedback. If there seems to be a disconnect, reflect what has been

said by paraphrasing. ―What I‘m hearing is,‖ or ―Sounds like you are
saying,‖ are great ways to reflect back. Don‘t simply repeat what the speaker
has said verbatim, though—you‘ll sound insincere or unintelligent. Instead,
express what the speaker‘s words mean to you. Ask questions to clarify
certain points: ―What do you mean when you say…‖ or ―Is this what you
mean?‖
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3. Pay attention to nonverbal signals
The way you look, listen, move, and react to another person tells them more
about how you‘re feeling than words alone ever can. Nonverbal
communication, or body language, includes facial expressions, body
movement and gestures, eye contact, posture, the tone of your voice, and
even your muscle tension and breathing.
Developing the ability to understand and use nonverbal communication can

help you connect with others, express what you really mean, navigate
challenging situations, and build better relationships at home and work.
 You can enhance effective communication by using open body

language—arms uncrossed, standing with an open stance or sitting on
the edge of your seat, and maintaining eye contact with the person
you‘re talking to.
 You can also use body language to emphasize or enhance your verbal
message—patting a friend on the back while complimenting him on
his success, for example, or pounding your fists to underline your
message.
Improve how you read nonverbal communication
Be aware of individual differences. People from different countries and

cultures tend to use different nonverbal communication gestures, so it‘s
important to take age, culture, religion, gender, and emotional state into
account when reading body language signals. An American teen, a grieving
widow, and an Asian businessman, for example, are likely to use nonverbal
signals differently.
Look at nonverbal communication signals as a group. Don‘t read too

much into a single gesture or nonverbal cue. Consider all of the nonverbal
signals you receive, from eye contact to tone of voice to body language.
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Anyone can slip up occasionally and let eye contact go, for example, or
briefly cross their arms without meaning to. Consider the signals as a whole
to get a better ―read‖ on a person.
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Improve how you deliver nonverbal communication
Use nonverbal signals that match up with your words rather than
contradict them. If you say one thing, but your body language says
something else, your listener will feel confused or suspect that you‘re being
dishonest. For example, sitting with your arms crossed and shaking your
head doesn‘t match words telling the other person that you agree with what
they‘re saying.
Adjust your nonverbal signals according to the context. The tone of your
voice, for example, should be different when you‘re addressing a child than
when you‘re addressing a group of adults. Similarly, take into account the
emotional state and cultural background of the person you‘re interacting
with.
Avoid negative body language. Instead, use body language to convey

positive feelings, even when you‘re not actually experiencing them. If you‘re
nervous about a situation—a job interview, important presentation, or first
date, for example—you can use positive body language to signal confidence,
even though you‘re not feeling it. Instead of tentatively entering a room with
your head down, eyes averted, and sliding into a chair, try standing tall with
your shoulders back, smiling and maintaining eye contact, and delivering a
firm handshake. It will make you feel more self-confident and help to put the
other person at ease.
3: Keep stress in check
How many times have you felt stressed during a disagreement with your
spouse, kids, boss, friends, or coworkers and then said or done something
you later regretted? If you can quickly relieve stress and return to a calm
state, you‘ll not only avoid such regrets, but in many cases you‘ll also help
to calm the other person as well. It‘s only when you‘re in a calm, relaxed
state that you‘ll be able to know whether the situation requires a response,
or whether the other person‘s signals indicate it would be better to remain
silent.
In situations such as a job interview, business presentation, high-pressure

meeting, or introduction to a loved one‘s family, for example, it‘s important
to manage your emotions, think on your feet, and effectively communicate
under pressure.
Communicate effectively by staying calm under pressure
Use stalling tactics to give yourself time to think. Ask for a question to be
repeated or for clarification of a statement before you respond.
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Pause to collect your thoughts. Silence isn‘t necessarily a bad thing—
pausing can make you seem more in control than rushing your response.
Make one point and provide an example or supporting piece of information.

If your response is too long or you waffle about a number of points, you risk
losing the listener‘s interest. Follow one point with an example and then
gauge the listener‘s reaction to tell if you should make a second point.
Deliver your words clearly. In many cases, how you say something can be
as important as what you say. Speak clearly, maintain an even tone, and
make eye contact. Keep your body language relaxed and open.
Wrap up with a summary and then stop. Summarize your response and
then stop talking, even if it leaves a silence in the room. You don‘t have to
fill the silence by continuing to talk.
10 Types of Communication Closest to a Universal Language

Love and kindness are the universal language of all creation.”
― Debasish Mridha
As more and more languages become extinct every year – an estimated 20

languages per year – the question of a universal language becomes
inevitable. Will the world someday – sooner rather than later – speak one
common language which will become a universal way for all humans to
communicate?
Here are ten forms of communication that are close to being universal
between the humans.
1. Facial Expressions
What we feel is what we express! This sentence is apt when it concerns our
facial expressions. Our face acts as a mirror to our feelings. Our facial
expressions change when we are happy, sad, angry or anxious.
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Facial expressions are form the primal form of communication. And these
expressions are shared alike across cultures.
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2. Gestures
Gestures act like an extension for facial expressions. Facial expressions,
when coupled with gestures often make a meaningful communication. For
instance, gestures play a pivotal role in signaling directions or to signal a
target of interest like you, him, her, etc.
Gestures vary across cultures. In western countries, eye-contact is

considered as an important part of any polite conversation while in Japan,
eye-contact is a sign of aggression.
3. Music
Henry Wadsworth Longfellow quotes ―Music is the universal language of all
mankind.‖ Music is often considered as a universal language just like love.
This quote of Longfellow has been backed by science as well.
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4. Emoticons
With the advancement of technology, we use some applications like
Whatsapp, Facebook and much more to connect with people from all parts
of the world. These applications offer a universal language called as
emoticons. Emoticons are used to express one‘s feelings and gestures.
Almost, every little thing that is used in our day-to-day life finds a place in
the emoticon section of our gizmos. For instance, if we agree with some
opinion, we only send a thumbs up emoji. Similarly, when we are happy, we
send a smiley face.
5. Hobo Signs
The hobo signs were used in the 1880s. They were non-verbal symbols that
were used until WWII. Emoticons are the refined version of the hobo signs.
Hobo code or symbols were widely used during the Depression where they
would appear on any clean and flat surface right from walls to fences. For
instance, a slanted T-shape indicated to get out fast while a tic-tac-toe
symbol was used to mark a house of policeman.
These symbols were language-independent. However, the primary challenge

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was the implementation of these symbols as a mode of communication.

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6. Sign Language
Sign language is an integral form of communication in the deaf community.
With sign language, deaf people who would have difficulty speaking and
learning language like people who can hear are able to communicate as
efficiently and seamlessly. However sign language has been an essential
aspect of communication throughout human history. Since the beginning of
human communication, sign language has changed and evolved into the
system that people see today.
7. English
English qualifies as among the top five candidates for the first universal
language owing to many factors. It is easy to learn and uses the Latin script
which makes it simple to write as well. English has been a language that is
associated with upward mobility.
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8. The Big Five Languages
According to Ethnologue, there are more than 7000 languages that are
spoken on Earth, most of them have restricted its set of speakers. Only eight
languages have more than 100 million native speakers, and around 4000
have less than 10000 speakers. 692 languages have less than 100 speakers,
and some of the languages are nearing extinct. For examples, out of 68
languages that are spoken in Mexico, Ayapaneco is the most endangered
one.
9. Math
Math is a universal language that describes the way the world works. Math
literacy is called as numeracy. All cultures follow arithmetic in a similar
pattern. For example, Pi is always regarded as the ratio of the circumference
of a circle to its diameter and is equal to 3.14.
10. Programming Languages

Computers connect us to people from all parts of the world with a mere
click. Right from banking to the Internet or looking for intelligent alien life,
everything can be done with the help of a human-devised programming
language. There are thousands of programming languages when it comes to
computing. They are written in the language of logic and math, with the help
of symbols that are taken from English.
SOURCE
https://www.look4ward.co.uk/lifestyle/universal-language-10-types-of-
human-communication/
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SELF CHECK 4.1-1
Choose the letter of the correcta answer
1. The way the term "communication" is used in this text

a. includes all human, animal, and mechanical communication
b. includes communion, as used in a religious sense
c. includes radio and television programming
d. includes none of these
2. "Communication is a process" means that

a. communication has clear beginning and ending points
b. communication resembles still pictures more than motion pictures
c. communication is ongoing and continuous
d. communication consists of discrete and separate acts
3. The same behavior in two different contexts may be perceived as

competent in one setting and incompetent in another. This situation best
illustrates the concept that communication competence
a. involves choosing inappropriate behavior
b. involves conflict
c. requires cognitive complexity
d. is situational
4. Journaling (keeping a private journal in which you write down your

feelings and thoughts with the intention that only you will read it) is an
example of
a. dyadic communication
b. intrapersonal communication
c. mass communication
d. interpersonal communication
5. Which of these is dyadic communication?

a. two sisters arguing
b. a husband and wife making plans for the weekend
c. a coach and player discussing last week's game
d. All of these are correct.
6. An example of self-monitoring is
a. videotaping your practice interview
b. carrying a checklist to remind you of some skills to practice
c. paying attention to the sound of your voice
7. When we say that communicators occupy different environments, we

mean that
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a. one might be rich and one poor.

b. one might be from China and one from the U.S.
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c. one might be retired with time on her hands, while one is rushing to
meet family and career demands with never enough time.
d. All of these represent differing environments.
8. A plane flying overhead and interfering with your conversation is an

example of __________ noise.
a. external
b. physiological
c. psychological
9. A universal language that describes the way the world works

a. English
b. Math
c. Filipino
d. Tagalog
10. An integral form of communication in the deaf community.

a. External language
b. Physiological language
c. Psychological language
d. Sign language
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ANSWER KEY 4.1-1
1. D
2. C
3. D
4. B
5. D
6. D
7. D
8. A
9. B
10. D
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“CLIENTS”
INTRODUCTION
The following ethical standards are relevant to the professional activities of

all social workers. These standards concern (1) social workers‘ ethical
responsibilities to clients, (2) social workers‘ ethical responsibilities to
colleagues, (3) social workers‘ ethical responsibilities in practice settings, (4)
social workers‘ ethical responsibilities as professionals, (5) social workers‘
ethical responsibilities to the social work profession, and (6) social workers‘
ethical responsibilities to the broader society.
Some of the standards that follow are enforceable guidelines for professional
conduct, and some are aspirational. The extent to which each standard is
enforceable is a matter of professional judgment to be exercised by those
responsible for reviewing alleged violations of ethical standards.
In today‘s world of speedy communication, people skills (also known as

emotional intelligence) are becoming more important.
8 Types of Clients and How to Deal With

Them
1. The unrealistic client
“Hey, I want this to be big and revolutionary. This all has to be done by next
month so we need to move quickly.”
This type of client is often a visionary -- coming to you with lots of big ideas
and expectations. The biggest obstacle understands what parts of the vision
are reasonable and feasible within the constraints of timeline and budget.
The fix: Start with a road map from the beginning. Set a timeline of goals
and projects, and set firm parameters on what can be accomplished within
your given parameters. It‘s important to validate the big ideas but ask ―can
we do this?‖ with our limitations to keep the focus on the attainable.
2. The "VIP" and its counterpart -- "I have other options"

“I decided to hire you for this, but don’t let me down because I can take my
business elsewhere. I will pay for everything once the work is done.”
Every client is important, but the VIP wishes to be placed above all others.
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They tend to position themselves in a manner that demands your sole focus.
This is most apparent in the frequent, often repetitive and unnecessary,
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reply. After all, what could be more important? VIP status often goes hand in
hand with the "I have other options" attitude. These are the clients who
make you feel like you are always on the edge of losing the job if you do not
meet their high standards.
The fix: It is possible to demonstrate that your client is a priority while still
setting boundaries and space for your other projects. By setting specific
touchpoints with the client, you are acknowledging the importance of their
project to you. These specific appointments also set the appropriate
timeframe for client contacts. You are most effective with a focused
objective. At the same time, be prepared to walk away from these types of
clients if they continue to make you feel inferior and don't value your role.
3. The micromanager
“Hey (just) checking in to make sure everything is going well, I texted you last
night and haven’t heard back.”
As experts in the field, we are hired to complete a job that our clients cannot
complete themselves. A micromanager has a hard time acknowledging this
distinction. They will try to stay on top of you throughout the entire process,
often questioning tiny details, checking your work against their own experts,
and wanting near-constant updates. This client is notoriously hard to
satisfy, even when they hang on every detail from start to finish.
The fix: Much like the VIP, it‘s important to set boundaries. Establish early
on that you are the expert, and that your purpose is to take their vision and
run with it in ways that they cannot. Instill confidence and trust with set
checkpoints. While it‘s important to hear them out, it‘s equally important to
remember that you are there for a reason.
4. The urgent client

“Can we get this all done ASAP? It’s extremely important because I have to
submit everything by the end of the week and can’t miss the deadline.”
Some projects genuinely need to get done fast, but the urgent client is a
rebel without a cause. They want it done right away -- even if there is no
justification for the speed. Often, an urgent client‘s demands involve
sacrificing weekends or evenings and can often disappear after submission.
This all results in a compromise of quality for the sake of a manufactured
deadline.
The fix: What‘s the rush? Find out from the beginning if this is a matter of
true urgency or client impatience. If there‘s no real fire to put out, assure
the client that you can create both quality and efficiency with just a little
extra time. From there, create a deadline that meets everyone‘s needs.
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5. The "NYCMNYD" (Now you see me, now you don't) client
“Hey, sorry, I haven’t been on my phone. Let’s jump on a call as soon as we
can and I’ll take care of the invoice by today.”
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Tricky to detect, The NYCMNYD can often be mistaken for the urgent client
at first glance. Instead, this describes a client that appears enthusiastic and
ready to work out of the gate, only to disappear when questions arise or
reviews are needed. They will often reach out absentmindedly without a
clear grasp of where the product is because of their disappearance. Be
warned: if not handled properly, Thy NYCMNYD can easily turn into a
postponer with delayed calls and meetings turning into confusion and
missed deadlines.
The fix: It is important to set expectations clearly and in writing from the
beginning. A contract can often be the key to keeping clients and yourself on
task and at the table. When the contact is waning, reaffirm that the timeline
established is important to their success. It‘s also important to keep in mind
that, while it‘s important to follow up, do not waste your time chasing them
down. Your time is equally important.
6. The "yes, no, maybe" client

“I think this is a good option, but I feel like it can be even better, but I am not
sure how I feel. What are your thoughts?”
Decisions, decisions. The "yes, no, maybe" client will struggle with them all.
They may try to rely on you to make all decisions, or they may feel the need
to get third and fourth opinions, leading to delays and loss of direction. They
also struggle with focus and will not offer feedback when needed. This can
lead to mid-project directional changes, extending deadlines, or
dissatisfaction with the final product.
The fix: Yes, no, maybes need a gentle but firm hand steering them in the
right direction. Find a focus quickly, and keep written records to help
prevent changes midstream. It‘s important to have a clear "why" for
decisions to help prevent wavering. Don‘t be afraid to say no to last-minute
course reversals that don‘t make sense. Follow up at clear milestones and
interact at the end of each to ensure everyone is on the same page and on
task. These clients more than any need you to show your expertise to create
a successful working relationship and final product.
7. The "behind the times" and the "viral sensation" clients

“We’ve done it this way for the last 20 years, can we keep it the same?” or “I
have a bunch of ideas to make us go viral!”
These two clients are on polar opposite ends of the spectrum but with very
similar results and solutions. The "Behind the times" client wants to stick
with what they know. They describe themselves as ―traditional‖ and are
resistant to innovation. The "viral sensation" client has the opposite
problem. They want to jump on every trend, latching on to a meme or viral
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video and attempting to stretch their brand to fit in a box where it doesn‘t
belong. They envision an impossible outcome with a strategy that really
doesn‘t fit their company or goals.
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The fix: While it may be counter-intuitive, both of these clients need the
same thing: YOU. Explaining the why behind the channels and techniques
that will work for them is important to push the traditionalists out of their
comfort zone and to bring the virals back down to reality. Set the direction
away from fads with focused content and an expert vision.
8. The grasshopper
“That’s great but have you ever thought about doing this instead….”
The grasshopper is a hard client to pin down. They hop from one idea to the
next without structure. You may find yourself struggling to bring them to
the table, and dialing in the project to one point of focus can be even more of
a challenge. On task is not in this client's vocabulary.
The fix: This client needs you to provide the structure to reach goals. It‘s a
good idea to write down all of your questions and points of discussion in
advance to avoid missing any crucial points during frequent topic changes.
SOURCE
https://www.entrepreneur.com/article/346299
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SELF CHECK 4.2-1
1. They want it done right away -- even if there is no justification for the
speed.
a. The urgent client
b. The micromanager
c. The "VIP" and its counterpart
d. The unrealistic client
e. The "yes, no, maybe" client
2. This client is notoriously hard to satisfy, even when they hang on every
detail from start to finish.
b. The micromanager
3. This type of client is often a visionary -- coming to you with lots of big
ideas and expectations.
b. The micromanager
4. They will often reach out absentmindedly without a clear grasp of where
the product is because of their disappearance.
a. The "NYCMNYD"
b. The micromanager
5. They may try to rely on you to make all decisions, or they may feel the
need to get third and fourth opinions, leading to delays and loss of direction.
a. The "NYCMNYD"
b. The micromanager
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ANSWER KEY 4.2-1
1. A
2. B
3. D
4. A
5. E
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“RESPECT FOR DIFFERENCES”
INTRODUCTION
We're all different – because of who we are, where we come from, what we
believe in, and how we live our lives.
But we all have value as human beings. And, with the right approach, our
differences can improve our experience at work, and enhance what we can
achieve together.
To do this, we need to create environments in which everyone feels

welcomed, fairly treated, and fully supported to do their best. In short, it's
about prioritizing mutual respect.
In this article, we explore the benefits of mutual respect. We also outline the
challenges to doing so and provide you with practical steps to build mutual
respect in your workplace.
What Is Respect?
Respect is the foundation of humane and ethical behavior, and mutual
respect underpins good relationships. To have respect for a person involves
a fundamental belief in their right to exist, to be heard, and to have the
same opportunities as everyone else.
Respect doesn't mean ignoring people's differences, or simply tolerating

them. Rather, it involves recognizing differences, understanding their
significance, and responding with interest, politeness and care.
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Mutual respect is also based on a shared belief in the benefits of diversity –

the variety of backgrounds, abilities and viewpoints within your team.
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But it also means looking beyond differences. With mutual respect, you
avoid labeling people in unhelpful ways. Instead, you celebrate the unique
things that each of us brings – and capitalize on all that we have in
common.
Mutual respect should be apparent throughout the workplace, from policies

and processes to individual interactions. It has a guiding role to play in face-
to-face meetings, written communications, body language , and the ways in
which people behave together.
You can still tackle difficult conversations, as long as you do so with tact
and diplomacy . And of course you don't have to agree with other people's
ideas or beliefs. You can still form friendships and alliances. You can feel
proud of your individuality, and of any connections you share with others at
work.
But be sure to contribute to the culture of respect. Mutual respect can only
be achieved when everyone sees it as a crucial and positive force at work.
10 Ways to Respect Differences
Everyone is different, and it is important to be sensitive to that fact.

Children look up to their parents and will imitate their behavior, so the way
you act towards others who are different can have a profound impact on
them. By making sure you are respectful to everyone, you can ensure your
children will do the same. In this week of our parenting tips series, we have
1. Be courteous and friendly to others. You can help your child respect
others by the way you greet people, talk with them, and talk about them
afterwards. Children learn from our example.
2. Make a family book about similarities and differences: You and your
child could work together to make a book about the people in your family.
3. Value difference. Arrange a small get-together with one or two families.

Each could make a snack that may be different or new to the others,
possibly an ethnic food or one that is special in other ways for their family.
4. Meet new friends. You may want to tell your child about a time when you
met someone who seemed different at first but as you got to know the
person, you came to appreciate him or her.
5. Use empathy: Can your child remember coming into a group and feeling
ignored or left out? Talking about your child‘s feelings can help your child
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develop empathy and begin to see things from another person‘s point of
view.
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6. We believe that we are all special people.

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7. Treat others kindly even if they are different.
8. We show we are listening by what we say.
9. We are concerned about each other‘s feelings.
10. Use books, the internet and society to introduce your child to difference
and in particular all types of families and how they are all unique and
special – just like ours.
SOURCE
https://www.mindtools.com/pages/article/mutual-respect.htm
https://onefamily.ie/10-ways-to-respect-difference/
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SELF CHECK 4.3-1
1. Which of the following is an example of appreciating diversity?

a. Treating women fairly
b. Tolerating people from different racial groups
c. Respecting and enjoying cultural and individual differences
d. Treating people from other ethnic groups fairly
2. Which of the following is NOT an aspect of understanding cultural

differences?
a. Cultural intelligence
b. Tolerance for all workers
c. Cultural sensitivity
d. Respect for all workers
3. What is cultural intelligence?

a. Ability to interpret someone's unfamiliar and ambiguous behavior the
same way that others of the person's culture would
b. Ability to speak another language
c. Ability to observe and accept unfamiliar and ambiguous behaviors in
others
d. Ability to research cultural differences
4. What are three sources of cultural intelligence?

a. Cognitive, emotional, and motivational
b. Cognitive, emotional, and physical
c. Fact, action, and feeling
d. None of the above.
5. Which of the following is least consistent with U.S. values in general?

a. Openness and accessibility
b. Egalitarianism
c. Individual competition
d. Emphasis on change
6. What is the purpose of diversity training?

a. Increase tolerance
b. Improve communication skills
c. Increase cultural knowledge
d. Increase workplace harmony
7. Which of the following is NOT a strategy that will help overcome

communication barriers?
a. Pay attention to individual differences in appearance.
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b. Use straightforward language and speak clearly.

c. Be sensitive to nonverbal communication differences.
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d. Politely insist that only English be spoken, even in international
situations.
8. Which of the following statements about improved cross-cultural

understanding is true?
a. It can attract new employees.
b. It can attract customers.
c. It can improve employee retention.
d. All of the above.
9. What is the premise that supports cross-generational training?

a. Cognitive awareness is all that's needed.
b. Workers need to accept people's differences, including those that
might be age-related.
c. Older people need to learn from younger people.
d. Young employees call in sick too often.
10. What is the basic, driving reason that top-level management at many
companies emphasizes cross-cultural understanding, including overcoming
communication barriers?
a. So employees get along better
b. Because such activities improve profits
c. To avoid being sued for discrimination
d. To meet federal guidelines
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ANSWER KEY 4.3-1
1. C
2. B
3. A
4. B
5. A
6. D
7. D
8. D
9. B
10. B
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“CONFIDENTIALITY AND PRIVACY OF CLIENT”
INTRODUCTION
The basic rights of human beings for independence of expression, decision,

and action, and concern for personal dignity and human relationships are
always of great importance. During sickness, however, the presence or
absence of these rights becomes a vital, deciding factor in survival and
recovery. Thus, it becomes a prime responsibility for hospitals to endeavor
to assure that these rights are preserved for their patients.
In providing care, hospitals have the right to expect behavior on the part of
patients and their relatives and friends, which considering the nature of
their illness, is reasonable and responsible.
This statement does not presume to be all-inclusive. It is intended to convey

the Joint Commission‘s concern about the relationship between hospitals
and patients and to emphasize the need for the observance of the rights and
responsibilities of patients.
What is Confidentiality?
The principle of confidentiality is about privacy and respecting someone‘s
wishes. It means that professionals shouldn‘t share personal details about
someone with others, unless that person has said they can or it‘s absolutely
necessary. ‗Professionals‘ in this context includes people like doctors,
nurses, social workers, support workers, and employers.
In a health and social care setting, confidentiality means that the

practitioner should keep a confidence between themselves and the patient,
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as part of good care practice. This means that the practitioner shouldn‘t tell
anyone what a patient has said and their details, other than those who need
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to know. This also includes not showing anyone – again, other than those
who need to know – an individual‘s personal notes or computer records.
The following basic rights and responsibilities of patients are considered

reasonably applicable to all hospitals.
Patients Rights
Access to Care. Individuals shall be accorded impartial access to treatment

or accommodations that are available or medically indicated, regardless of
race, creed, sex, national origin, or sources of payment for care.
Respect and Dignity. The patient has the right to considerate, respectful
care at all times and under all circumstances, with recognition of his
personal dignity.
Privacy and Confidentiality. The patient has the right, within the law, to
personal and informational privacy, as manifested by the following rights.
 To refuse to talk with or see anyone not officially connected with the
hospital including visitors, or persons officially connected with the
hospital but not directly involved in his care.
 To wear appropriate personal clothing and religious or other symbolic
items, as long as they do not interfere with diagnostic procedures or
treatments.
 To be interviewed and examined in surroundings designed to assure
reasonable visual and auditory privacy. This includes the right to have
a person of one‘s own sex present during certain parts of a physical
examination, treatment, or procedure performed by a health
professional of the opposite sex and the right not to remain disrobed
any longer than is required for accomplishing the medical purpose for
which the patient was asked to disrobe.
 To expect that any discussion or consultation involving his case will
be conducted discreetly and that individuals not directly involved in
his care will not be present without his permission.
 To have his medical record read only by individuals directly involved
in his treatment or in the monitoring of its quality. Other individuals
can only read his medical record on his written authorization or that
of his legally authorized representative.
 To expect all communications and other records pertaining to his
care, including the source of payment for treatment, to be treated as
confidential.
 To request a transfer to another room if another patient or a visitor in
the room is unreasonably disturbing him.
 To be placed in protective privacy when considered necessary for
personal safety.
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Personal Safety. The patient has the right to expect reasonable safety
insofar as the hospital practices and environment are concerned.
Identity. The patient has the right to know the identity and professional
status of individuals providing service to him and to know which physician
or another practitioner is primarily responsible for his care. This includes
the patient‘s right to know of the existence of any professional relationship
among individuals who are treating him, as well as the relationship to any
other health care or educational institutions involved in his care.
Participation by patients in clinical training programs or in the gathering of
data for research purposes should be voluntary.
Information. The patient has the right to obtain, from the practitioner
responsible for coordinating his care, complete and current information
concerning his diagnosis (to the degree known), treatment, and any known
prognosis. This information should be communicated in terms the patient
can reasonably be expected to understand. When it is not medically
advisable to give such information to the patient, the information should be
made available to a legally authorized individual.
Communication. The patient has the right of access to people outside the
hospital by means of visitors and by verbal and written communication.
When the patient does not speak or understand the predominant language
of the community, he should have access to an interpreter. This is
particularly true where language barriers are a continuing problem.
Consent. The patient has the right to reasonable information and

228
participation in decisions involving his health care. To the degree possible,

this should be based on a clear, concise explanation of his condition and of
all proposed technical procedures, including the possibilities of any risk of
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COMMON COMPETENCY
probability of success. The patient should not be subjected to any procedure
without his voluntary, competent, and understanding consent or the
consent of his legally authorized representative. Where medically significant
alternatives for care treatment exist, the patient shall be so informed.
 The patient has the right to know who is responsible for authorizing
and performing the procedures or treatment.
 The patient shall be informed if the hospital proposes to engage in or
perform human experimentation or other research/educational
projects affecting his care or treatment; the patient has the right to
refuse to participate in any such activity.
Consultation. The patient, at his own request and expense, has the right to
consult with a specialist.
Refusal of Treatment. The patient may refuse treatment to the extent

permitted by law. When refusal of treatment by the patient or his legally
authorized representative prevents the provision of appropriate care in
accordance with professional standards, the relationship with the patient
may be terminated upon reasonable notice.
Transfer and Continuity of Care. A patient may not be transferred to

another facility or organization unless he has received a complete
explanation of the need for the transfer and of the alternatives to such a
transfer and unless the transfer is acceptable to the other facility or
organization. The patient has the right to be informed by the practitioner
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responsible for his care, or his delegate, of any continuing health care
requirements following discharge from the hospital.
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Fees or Hospital Charges. Regardless of the source of payment for his care,
the patient has the right to request and receive an itemized and detailed
explanation of his total bill for services rendered in the hospital. The patient
has the right to timely notice prior to termination of his eligibility for
reimbursement by any third-party payer for the cost of his care.
Hospital Rules and Regulations. The patient should be informed of the

hospital rules and regulations applicable to his conduct as a patient.
Patients are entitled to information about the hospital‘s mechanism for the
initiation, review, and resolution of patient complaints.
Pain Management. The patient‘s right to pain management will be

respected and supported. As a patient, you can expect:
 Information about pain and pain relief measures.
 A concerned staff committed to pain prevention.
 Health professionals who respond quickly to reports of pain.
 State-of-the-art pain management.
SOURCE
https://www.privacy.gov.ph/data-privacy-act/
https://www.highspeedtraining.co.uk/hub/confidentiality-in-health-and-
social-care/
https://www.tcrh.org/for-patients-and-visitors/patient-rights-
responsibilities
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SELF CHECK 4.3-2
1. From a relational-multicultural perspective, maintaining client

confidentiality is based on
a. fear of getting sued
b. a need to hear private personal information about other people
c. care for the dignity and privacy of the client
d. fear of disciplinary action from licensing boards
2. Confidentiality promotes positive changes in clients because it helps

provide a context for the experience of
a. safety
b. positive emotional experiences
c. trust
d. all of the above
3. HIPAA is a federal statute designed to

a. limit the fees counselors can set
b. determine what kinds of mental health providers clients can go to
c. protect the privacy of clients‘ personal health and mental health
information
d. set clinical standards for psychotherapy
4. From a risk management perspective, protecting client confidentiality is a

primary value in order to reduce the risk of______________.
a. client dissatisfaction
b. premature termination from counseling
c. client suicide
d. malpractice claims and other civil lawsuits
5. Counselors who understand confidentiality from Perspective III ethics

a. are at reduced risk of professional burnout and are likely to be more
professionally creative
b. appreciate that confidentiality springs from the principle of care for
the welfare of the client
c. have a broader understanding of the importance of confidentiality
than fear of lawsuit or professional sanction
d. all of the above
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ANSWER KEY 4.3-2
1. From a relational-multicultural perspective, maintaining client
confidentiality is based on
a. fear of getting sued
b. a need to hear private personal information about other people
c. care for the dignity and privacy of the client
d. fear of disciplinary action from licensing boards
2. Confidentiality promotes positive changes in clients because it helps

provide a context for the experience of
a. safety
b. positive emotional experiences
c. trust
d. all of the above
3. Philippine Health Information Exchange (PHIE) is a federal statute

designed to
a. limit the fees counselors can set
b. determine what kinds of mental health providers clients can go to
c. protect the privacy of clients’ personal health and mental health
information
d. set clinical standards for psychotherapy
4. From a risk management perspective, protecting client confidentiality is a

primary value in order to reduce the risk of______________.
a. client dissatisfaction
b. premature termination from counseling
c. client suicide
d. malpractice claims and other civil lawsuits
5. Counselors who understand confidentiality from Perspective III ethics

a. are at reduced risk of professional burnout and are likely to be more
professionally creative
b. appreciate that confidentiality springs from the principle of care for
the welfare of the client
c. have a broader understanding of the importance of confidentiality
than fear of lawsuit or professional sanction
d. all of the above
x x x x x END x x x x x
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COMMON COMPETENCY

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COMPETENCY STANDARDS

HILOT (WELLNESS MASSAGE) NC II

This HILOT (WELLNESS MASSAGE) NC II Qualification consists of competencies

The Units of Competency comprising this Qualification include the following:

Unit Code BASIC COMPETENCIES

Unit Code COMMON COMPETENCIES

Unit Code CORE COMPETENCIES

HILOT (WELLNESS MASSAGE) – LEVEL II

HILOT (WELLNESS MASSAGE) – LEVEL II

Once a positive case of COVID-19 has been identified, it is followed up with

Case investigations identify and investigate patients with confirmed and

Why is contact tracing important?

Contact tracing is a mitigation strategy meant to slow the spread of COVID-

HILOT (WELLNESS MASSAGE) – LEVEL II

What to expect with contact tracing?

HILOT (WELLNESS MASSAGE) – LEVEL II

1. A written statement of policies and principles that guides the behavior of

2. An empirical inquiry into the actual rules or standards of a particular

4. Which of the following is not usually the objective of a code of ethics?

HILOT (WELLNESS MASSAGE) – LEVEL II

HILOT (WELLNESS MASSAGE) – LEVEL II

A risk assessment is a thorough look at your workplace to identify those

An infection risk assessment considers potential hazards and prioritizes

Risk assessment – the overall process of hazard identification, risk analysis,

Hazard identification – the process of finding, listing, and characterizing

Risk analysis – a process for comprehending the nature of hazards and

Risk evaluation – the process of comparing an estimated risk against given

Risk control – actions implementing risk evaluation decisions.

HILOT (WELLNESS MASSAGE) – LEVEL II

 Create awareness of hazards and risk.

Assessing the Population

Organization and Patient Population Assessment

Selecting the outcome or process for surveillance

HILOT (WELLNESS MASSAGE) – LEVEL II

Update no less than annually; use as a tool to evaluate your infection

HILOT (WELLNESS MASSAGE) – LEVEL II

Risk assessment not produced in the IP‘s office

Collaborative Tools for Learning

HILOT (WELLNESS MASSAGE) – LEVEL II

The Joint Commission

HILOT (WELLNESS MASSAGE) – LEVEL II

1. The process of finding, listing, and characterizing hazards.

2. The process of comparing an estimated risk against given risk criteria to

3. Actions implementing risk evaluation decisions.

4. The overall process of hazard identification, risk analysis, and risk

5. A process for comprehending the nature of hazards and determining the

HILOT (WELLNESS MASSAGE) – LEVEL II

HILOT (WELLNESS MASSAGE) – LEVEL II

Therapeutic communication is defined as the face-to-face process of

Therapeutic communication is a collection of techniques that prioritize the

Active Listening, Touch, & Space

HILOT (WELLNESS MASSAGE) – LEVEL II

Active listening involves verbal communication, such as when a nurse

Another kind of nonverbal therapeutic communication technique is touch.

Similarly, another important nonverbal communication technique is that of

Therapeutic Communication Techniques

There are a variety opens of therapeutic communication techniques nurses

Nurses should always let patients break the silence.

HILOT (WELLNESS MASSAGE) – LEVEL II

Acceptance isn‘t necessarily the same thing as agreement; it can be enough

A compliment can sometimes be taken as condescending, especially when it

HILOT (WELLNESS MASSAGE) – LEVEL II