IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY

DEPARTMENT OF DISASTER MEDICINE AND MILITARY MEDICINE

First Pre Medical

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Lecture L. V. Levchenko

Ivano-Frankivsk – 2019
• About 90% of combat deaths occur on the ground before the casualties
reach the medical treatment facility. Many of these deaths cannot be
prevented, BUT with quick reaction and simple techniques lives can be
saved.
• Every day in the world there are thousands of emergencies, which
lead to injuries and death of people, to considerable material losses
• To emergencies belong accidents, catastrophes, natural disasters, social
disasters and other massive injuries which occur at peace and war
time
• When providing medical care in case of emergency it is essential to
know for all health workers rules of conduct and methods of
providing first aid which have been developed.
• Emergency situations in the narrow sense, are any sudden events that
pose a severe threat to the life or health of a human and require
immediate targeted intervention.
• Emergency medicine does not require a doctor to be a specifically
specialized, but a general practitioner with special skills therefore can
define life-threatening emergency situations and is able to support
vital functions, especially breathing and blood circulation.
• According to the World Health Organization, about 30% of people who died in
emergency situations could have been saved, provided timely and correct emergency
medical care (EMH)
The purpose of the EMD
save human’s life;
elimination or reduction of the effect of the damaging factor;
carrying out medical measures that restrain the development of the complications
and consequences of the loss, threatening to life

SANITARY LOSSES AT THE TIME OF EMERGENCY SITUATION

arise, as a rule, suddenly;
are massive in such a way that they exceed the capacity of the health care
system to provide medical care to victims in the best way to save their lives;
principles and methods of treatment that are used under normal conditions -
ineffective;
taking into account these features, it is necessary to apply the special
organizational principles of assistance, most of which are derived from the experience
of military medicine
 PHASES OF PROVIDING MD IN ANOTHER EMERGENCY
SITUATION

Isolation phase lasts Phase of rescue Evacuation

from the moment of the from the beginning of
emergence of the phase is
life-saving works to characterized by
country and to the
beginning of rescue
the completion of the scheduled treatment
work. In this phase, the evacuation of victims of affected and end-
victims are without help. outside the cells of of-life consequences
the country. in health facilities
Duration of the  
phase is from minutes In this phase, they
to hours. provide urgent
Therefore, it is
medical care for vital
necessary to know the
rules of conduct in the
signs and prepare
area of the country and victims for evacuation
the methods of self-help to health facilities
and mutual assistance
 EXTERNAL MEDICINAL AID MEASURES

Extracting victims from cars, debris and other places;

The extinguishing of burning clothes and combustible mixtures on the body;
Clothing of individual means of protection on the contaminated area;
Introduction of antidote poisoning;
Diagnosis and removal of asphyxiation;
Exemption from compression clothing (collar, belt);
Conduction of closed heart massage and artificial respiration;
Sealing band with open pneumothorax;
Stop external and internal bleeding;
Applying an aseptic bandage on the wound, burning surface;
Introduction of analgesic substance;
Immobilization of damaged extremities;
Providing the physiologically advantageous position of the victim's body;
Warm up the victim by drinking water or saline solution;
Permanent contact with the victim and moral support;
 PRINCIPLES OF MEDICAL AID PROVIDING

• The main rule is to make sure that you are in a safe environment!
• If you are in danger - do not get close to the victim!
• Your actions should not increase the number of casualties!

 Find out what happened, find out the traumatic factors;

 Find out the number of victims;
 To find out the present injuries in the victims and their severity;
 As far as you are able to help around;
 Call an Emergency;
 Conduct an initial survey of the victim and provide him with an EMD;
 Conduct a secondary inspection of the victim and provide assistance in detecting other
injuries;
 Constantly monitor the victims, maintain contact with them and calm down before the
arrival of "Ambulance";
 If the arrival of rescue services is difficult - to ensure the transport of the victim to a
medical institution.
 If the victim is drunk:
• try to calm him/her down;
• explain who you are and offer your services;
• explain what you want to do;
• if the victim is unconscious, you are obliged to provide an
EMH
EXAMINATION OF CASUALTY
Danger
Response
Airway
Breathing
Circulation
The initial examination of a casualty is the key to life saving.
Information obtained during this first assessment will not only guide
the First Aider but will also provide valuable information to Medical
professionals once the casualty is handed over to their care
 Response – level consciousness AVPU
• A The person is alert, knows who he is, the date, where he is, and so
forth.
• V The person responds to verbal commands, but is not alert.
• P The person only responds to pain, not verbal commands.
• U The person is unresponsive(unconscious).
• Re-check every 15 minutes
If the person only responds to verbal commands then their level of
consciousness may be deteriorating. The above will still apply but the first
aider must monitor them carefully.
The casualty may only respond to pain. This is when the first aider
touches an area of his/her body which has incurred injury. He/she may
moan or flinch but other than that they are unable to speak to the first
aider and are clearly only semi-conscious.
If the casualty is not responding at all, then they are classed as being
unconscious.
 RESPONSE – LEVEL CONSCIOUSNESS AVPU
• Try to approach the casualty from the feet if possible as this
will be less threatening if he/she is only semi-conscious.
• Kneel beside him/her and ask if he/she is OK and if he/she
can hear you.
• Speak loudly in case the casualty is asleep or only
semiconscious.
• Shake him/her by the shoulders or touch his/her hand.
• You can ask him to squeeze you hand if he can hear you to
see if you get a response.
• If there is no response then you must quickly move on to
check the airway
OPEN THE AIRWAY BY CARRYING OUT THE CHIN LIFT AND
HEAD TILT.
• Once the airway is open, the first aider needs to check to
see if the casualty is breathing.
• This is done by placing the side of the head next to the
casualty’s mouth so that he/she will feel any air being
exhaled, whilst looking down the chest to see if it is rising
and falling.
• At the same time, it should be listened for the sound of
breathing. If after 10 seconds of checking for breathing the
first aider has not been able to see hear of feel anything
he/she must assume that the casualty is not breathing and
commence CPR, (Cardio- (heart) Pulmonary (breathing)
Resuscitation).
• C - Compressions: Place the heel of your hand on the center of the victim's
chest. Put your other hand on top of the first with your fingers interlaced.
Press down so you compress the chest at least 2 inches in adults and
children and 1.5 inches in infants. One hundred times a minute or even a
little faster is optimal. (That's about the same rhythm as the beat of the
Bee Gee's song "Stayin' Alive.")

• A - Airway: If you've been trained in CPR, you can now open the airway
with a head-tilt and chin-lift maneuver.

• B - Breathing: Pinch the victim's nose closed. Take a normal breath, cover

the victim's mouth with yours to create an airtight seal, and then give two,
one-second breaths as you watch for the chest to rise. Continue
compressions and breaths -- 30 compressions, two breaths -- until help
arrives
• The First Aider should kneel next to the casualty and place the heel of one
hand on the centre of the chest, place the heel of the other over the top and
link the fingers, pressing down about 5-6cm and releasing.
• Each compression should be given at a Police Tactics & Techniques First Aid
• 10 UN Peacekeeping PDT Standards for Formed Police Units 1st edition 2015

• rate of 100-120 per minute (about half a second each).

• After 30 compressions, the First Aider should tilt back the head and place
two breaths into the casualty, watching the chest rise and fall to see that the
air has gone into the body.
• He then carries on with another 30 compressions followed by another two
breaths until the casualty recovers,
• Medical assistance arrives and takes over or the First Aider is so tired that if
he continued he would also become a casualty.
• Where the checks have been done and the casualty is breathing but unconscious,
he/she should be placed in the Recovery Position to maintain their airway.
• The First Aider can carry out a more in depth check of the casualty to see if they can
ascertain the cause of their unconsciousness, prior to putting them in the recovery
position, and if they encounter any bleeding deal with it accordingly

If the unconscious sufferer breathes and does not have other injuries – he/she should
not be moved , the head and neck should be supported in a steady state till Ambulance
arrive.
 CLOSED HEART MASSAGE
SIGNS OF HEART STOP

the victim is unconscious;

no pulse, in particular on the carotid arteries;
no breathing;
skin and mucous membranes become pale or cyanotic;
maximally enlarged pupils;
Cramps at loss of consciousness may be the first sign of stopping the heart
INDICATORS OF THE EFFECTIVENESS OF HEART MASSAGE
• the appearance of pulse on large arteries;
• narrowing the pupils;
• skin color normalization;
• the appearance of respiratory movements.
HEART MASSAGE TECHNIQUE
• The victim lays on a solid foundation. The reanimator becomes on the side and
hand palms on the middle of the sternum with the whole body of the body
with a frequency 100 times per minute, without removing hands from the
sternum
 RECOGNITION OF AGONAL RESPIRATION.
• At cardiac arrest, convulsions or agonistic breathing may be observed. Ask if the
victim is in consciousness. A reanimator should initiate CPR if the victim does
not breathe or suffocates.
Generalized convulsions
may be the first sign of heart failure
• The importance of compressive compression of the chest. Compressive
compression should be performed by all intensive care units. If an accidental
witness is not trained in CPR, he must perform it without lung ventilation, that
is, "sharply and often press" at the center of the chest of the victim, who
suddenly became unconscious. The resuscitator should continue CPR before the
arrival of the emergency medical team.
• - If the victim is unconscious and does not breathe or suffocates, the intensive
care unit should call the emergency medical aid.
• - If you can not determine the pulse for 10 seconds, you must proceed to CPR
and perform external defibrillation
 TRAUMATIC SHOCK
• It is a medical condition where an individual perform an abnormal
behavior. It results in dysfunctioning of multiple organs and even to death.
Hypovolemic shock results due to loss of blood and neurogenic shock due
to destruction of spinal cord integrity are the common types of traumatic
shock. Primary treatment for traumatic shock must be supportive which
includes psychological trauma therapy.

ALLOCATE THE FOLLOWING TYPES OF SHOCK

 Traumatic shock (mechanical, thermal, electric trauma);

 Hemorrhagic or hypovolemic shock (blood loss, dehydration);
 Cardiogenic shock (myocardial infarction, acute heart failure);
 Septic shock (bacterial-toxic shock);
 Anaphylactic shock.
 WHEN TO USE AN AED

Use an AED on a person experiencing Sudden Cardic Arrest (SCA). Symptoms

include:
• Unable to respond when you try to wake them
• No breathing or abnormal breathing
• No detectable pulse
• Blue color in skin
• Person might move, spasm

Before using an AED:

• Confirm that the person cannot respond to shaking or shouting
• Call for help (or have someone else do it)
• Chance f survival increase if someone starts CPR while another gets the AED
• Make sure person is in a dry area ( no puddles, flowing water sources)
 First, power on the AED.
An AED can be used on an adult, child, or infant. Follow the AED prompts.
Place the AED near the victim’s head and power on the unit. Some
models require you to push a button to turn it on, while others turn on
automatically when you lift the lid.

Second, apply the AED pads.

 Expose the chest and wipe it dry of any moisture. Apply the pads to the
chest according to the pads.
Place one pad on the right side of the chest, just below the collarbone
Place the other pad on the lower left side of the chest
Connect the pads to the AED if they’re not already connected
If there are two trained rescuers, one performs CPR while the other
prepares the AED for use. The rescuer in charge of the AED will apply the
pads around the hands of the person giving chest compressions. Do not
stop CPR while the AED is being readied for use. The AED will prompt you
to stop CPR when it is ready to analyze the heart rhythm.

Third, clear the victim and shock. 

It is critical that no one touches the victim or his clothing while the AED
analyzes or delivers a shock.
When prompted by the AED to deliver a shock:
The AED user quickly looks up and down the entire victim to ensure no
one is touching him and loudly states, “Everybody clear.”
The rescuer can now push the shock button.
 PHYSICAL SIGNS OF DEATH
• A physician determines cause of death.
• Presumptive signs of death:
– Unresponsiveness to painful stimuli
– Lack of a carotid pulse or heartbeat
– Absence of breath sounds
– No deep tendon or corneal reflexes
– Absence of eye movement
– No systolic blood pressure
– Profound cyanosis
– Lowered or decreased body temperature
 DEFINITIVE SIGNS OF DEATH:

– A body in parts
(decapitation)
– Dependent lividity
(blood settling)
– Rigor mortis (stiffening)
– Putrefaction (decomposition)