CPR, FIRST AID and

EMERGENCY MEDICAL RESPONSE

for COMMUNITY RESCUERS

Roderick Esteban B. Ramirez, MD, MPH

F,SUPT (MS) BFP
R02
Chief Emergency Medical Service/
Rescue
 RECOGNIZE THE EMERGENCY
• “PAY ATTENTION TO UNUSUAL SIGTHS,
SMELL, SOUNDS AND SITUATIONS”
• A person who is unresponsive or appears seriously
injured
• Screams or panicked local expressions
• A collision or vehicle stopped in an unusual
location
• A suspicious environment overturned furniture,
disturbed plants, opened chemical or medication
container, broken glass, blood, etc.
• Environmental hazards like fire, flooding, damages
 ON SCENE ARRIVAL
• Arriving on scene of a major incident can be both
mentally challenging and physically dangerous
• Staying alert and aware on the scene of any
accident should be a responders no. 1 duty
• Remember, you can help no one if you are
injured
• Remember SAFETY FIRST
 PHYSICAL CONCERNS
• Unstable environment
• Crowd control
• Risk of whatever caused the original event
(explosions, chemical spill)
• Have a thorough scene evaluation
• Remember not to focus on one thing: keep an eye
on the big picture
• Employ any available help to assist in crowd
control
• Wear proper protective equipment
 ENVIRONMENT SAFETY
• “ SIZE UP THE SCENE FROM DANGER BEFORE YOU
ENTER. If scene does not look safe do not enter.
Secure the area, keep others out and call for help”
1. Traffic
2. Fire or smoke
3. Wet, icy or unstable surface or structure
4. Downed power lines
5. Hazardous material, chemicals or gases
6. Open water and strong currents
7. Confined spaces
8. Possible crime scenes and volatile crowd
 SIZE UP THE VICTIMS
• Size up the victim from a safer side
• Check how many victims
• What is the general condition of the victims
• Can you identify the cause of Illness or injury?
 ASSESS THE VICTIM
• When you get to the victim’s side, assess if there is
danger or if the victim is unresponsive or seriously
ill or injured.
• Send someone to call for help if available. If you are
not sure that it is an emergency, it’s better to call
for help
• Patient assessment can be done by anyone with
minimal level of training to greatly increase the
survivability of the victims
• Our goal is to stabilize the victims and to prolong
their life until advanced care is available.
 VITAL SIGNS
• Respiratory Rate 12-20 BPM
• Pulse Rate 60-80/ min Carotid or AXILLARY
• Check Cognitive Level
1. Alert: awake
2. Lethargic: Drowsy
3. Stuporous: Sleepy but awaken by verbal
stimuli
4. Obtunded: Sleepy but awaken by painful stimuli
5. Comatose: Totally unresponsive to anything
 ASSESSMENT BASIC
• AIRWAY: Head tilt chin lift (non trauma)
Jaw thrust (suspected cervical spine injury)
• BREATHING: Bag Valve Mask, Nasopharyngeal
Airway, Barrier Mask use maintain 12 BPM
• CIRCULATION: Carotid, Axillary or capillary refill
• CONTROL of BLOOD LOSS
• HEAD TO TOE SURVEY
 CALL FOR HELP
• Call 911 or 117, local police, local fire department,
hospital if there is danger or if the victim is
unresponsive or seriously ill or injured.
• Send someone else to call fro help if available.
• If you are not sure that it’s an emergency, its better
to call for help
 TREAT THE VICTIM
• Prioritize treating problems related to breathing
and circulations first.
• At every emergency you will assess the scene fro
safety, get the first aid kit and AED, put on your
personal protective equipment, and assess the
victim.
 HEART ATTACK
• Coronary Artery Disease
develops when fat and
cholesterol attaches to the
inner walls of the
coronary arteries leading
to the narrowing of the
lumen
(ATHEROSCLEROSIS).
• A heart attack occurs when a
clot blocks a narrowed
coronary artery, depriving
 SIGNS AND SYMPTOMS of HEART ATTACK
• Chest pain w/c is crushing, there is pressure on the
chest, tightness, squeezing and heaviness
• Pain radiating towards the arms, neck, jaws,
abdomen or back
• Shortness of breath
• Cold clammy perspiration
• Dizziness or fainting
• Nausea or vomitting
 UNUSUAL SYMPTOMS
• Women, diabetics and older persons may not
experience the typical symptoms of chest
discomfort and shortness of breath
• They are more likely to have other symptoms such
as jaw pain, nausea and vomiting and unexplained
fatigues
 FIRST AID
• Call 911, activate EMS, send someone to call for
HELP
• Place the patient in a comfortable position, high
back rest or sitting position
• Calm and reassure the patient that help is coming
along
• Remove the crowd, provide air and ventilation
• Provide Oxygen for the victim
• Give aspirin
STROKE or CVA
• A stroke is an injury to the brain caused by the
disruption of flow of blood to the brain. When
blood vessels becomes blocked or bursts,
oxygenated blood is unable to reach the part of the
brain which has an injury.
• It is then that the brain cells began to die.
• It is a life threatening condition that requires the
signals fast
• A Transient Ischeamic attack or mild strike is a
temporary lack of Oxygen supply to the brain
but there is a total recovery of the brain within
24 hours.
 SIGNS AND SYMPTOMS
• Weakness or numbness of the
face, arms or leg, usually on one
side of the body
• Difficulty of speaking or
swallowing
• Loss of balance or coordination,
difficulty of walking
• Decreased mental status
• Severe headache, dizziness
• Change in vision
 FIRST AID for STROKE
• Call 911 activate EMS
• If unresponsive and not breathing or only gasping
for air start CPR
• Protect the airway, if there are secretions place the
face sideways
• Be calm and reassure the victim.
• Note the time the symptoms occurred
• Provide oxygen
• Elevate the head of the patient.
 CHOKING/ AIRWAY OBSTRUCTION
• Choking is a common but preventable and manageable
emergency.
• Foreign body Obstruction of the airway commonly
occurs during eating
• Meat is the most common cause in adults
• Various food and foreign body cause choking in
children
• Assorted Factors
1. Large poorly chewed food
2. Elevated blood alcohol and other intoxicating
substances
3. Laughing, talking or playing while the mouth
is full
CHOKING
HEIMLICH MANUEVER
• The rescuer stands behind the
victim and wraps his arms
around the victim’s waist
• He makes a thumb fist
with one
hand and places the
thumb side
of the fist against the
victim’s
abdomen, slightly above the
umbilicus
• Rescuer grasps the fist with
the
other hand and presses into
the
victim’s abdomen with a quick
• As we do an upward
abdominal thrust , the
abdominal contents
primarily the intestines
pushes the diaphragm
upwards; thus pushing
whatever air is in the
lungs to cause the
propulsion of the
airway obstruction
 MILD AIRWAY OBSTRUCTION
• With mild airway obstruction, the person is able to
cough forcefully or even speak.
• Ask if he is choking
• Encourage him to cough
• Monitor for progression to severe obstruction
 SEVERE AIRWAY OBSTRUCTION
• A PERSON WITH SEVERE OBSTRUCTION COULD
HARDLY BREATHE, COUGH NOR SPEAK.
• He may have a high pitched sound when
inhaling
• Turns blue or cyanotic around the face or lips
• Act quickly to remove the obstruction or the person
will soon be unresponsive or die.
HEIMLICH MANUEVER
• The rescuer stands behind the
victim and wraps his arms
around the victim’s waist
• He makes a thumb fist
with one
hand and places the
thumb side
of the fist against the
victim’s
abdomen, slightly above the
umbilicus
• Rescuer grasps the fist with
the
other hand and presses into
the
victim’s abdomen with a quick
• As we do an upward
abdominal thrust , the
abdominal contents
primarily the intestines
pushes the diaphragm
upwards; thus pushing
whatever air is in the
lungs to cause the
propulsion of the
airway obstruction
 CHEST THRUST for PREGNANT
• If the rescuer cannot reach around the waist of a
large person or the victim is obviously pregnant use
chest thrust
• Place one fist in the middle of the chest on the
lower part of the sternum with thumb against the
chest
• Grasp the fist with your other hand and pull straight
back on the chest quickly and forcefully
• Continue until the object is expelled
 UNRESPONSIVE CHOKING PERSON
• When choking person becomes unresponsive
carefully lower the person to the ground.
• Use CPR to relieve the obstruction
• Send someone to call for HELP or dial 911
• Perform CPR with the added step mof looking in the
mouth after each set of compressions.
• If you see the obstruction remove it and continue
CPR
• Continue CPR until the person begins to breathe
normally
 INFANT CHOKING (less than a year)
• Most incident of choking in infants and young
children occur when parents or caregivers are close
by, usually during eating or playing
• Liquids such as juice or milk formula are the most
common cause of choking in infants
• An infant will not give the universal sign of choking.
Be alert and recognize the signs of Choking in
Infants
 Sudden onset of choking in Infants
• Unable to cry or cough
effectively
• Difficulty or no
breathing
• Wheezing or high pitched
sound
• Bluish skin discoloration
• Bulging or teary eyed
• Panic or distressed facial
expression
 SEVERE OBSTRUCTION
• Sit or kneel down, then hold the infant facedown on
your forearm with head slightly lower than the
chest
• Give 5 back slaps forcefully on the shoulder blades
• Support the infant between your arms and turn face
up with the head lower than the body
• Give 5 quick downward chest thrust on the lower
half of the sternum about 1 per second
• Repeat the sequence until the object is expelled,
the infant cries or becomes unresponsive
 UNRESPONSIVE INFANT
• When a choking infant becomes unresponsive,
place the infant on a hard, flat surface. Use CPR to
relieve the obstruction
• Send a bystander to call 911 for help
• Perform CPR with the added step of looking in the
mouth after each complete set of compressions. If
you see the obstruction, remove it con continue
CPR
• Continue the CPR until the infant begins to breathe
normally
 CONTROL of BLOOD LOSS
• Compression
Bandages
• Pressure
points
• tourniquets
 COMPRESSION BANDAGES
• Are simple and effective way of bleeding control
• They are simply a stack of bandages applied with a tight
wrap
• We can use a t-shirt or a towel
• If bleeding persist just add more bandaging materials
• Place a gauze or a clean absorbent on the injured site
• Wrap the injured site with a strong soft wrap
• Check for capillary refill nor pulse distal to the wrap
• Reassess the bandage at regular adding more
material as required
 TOURNIQUETS
• If severe bleeding from an arm or leg cannot be
controlled with direct pressure and help will be late,
try to consider a tourniquet as a last resort.
• It is a constricting device used to apply pressure to
stop bleeding. It has a strap to wrap around the
limb and a rod is use to tighten it.
• Apply tourniquet to the limb atleast 2” above the
injury
• Tighten the rod to the point that the bleeding
stops
• Record the time it is placed
• Notify EMS responders that a tourniquet was
PRESSURE POINTS to control Bleeding
AXILLARY and
FEMORAL
 BLEEDING, SHOCK and TRAUMA
• Control of severe bleeding by a rescuer is a critical
first aid treatment that can truly save a life.
• A victim of severe bleeding can die of blood loss
within just a few minutes
• Direct pressure with a gauze, applying pressure on
pressure points of the extremities ( UPPER: Axillary
LOWER: Femoral) or tourniquets can be use to
control bleeding
 EXTERNAL BLEEDING
• ARTERIAL: bright red spurting from the wound
• VENOUS: dark red steadily flowing from the wound
• CAPILLARY: Blood slowly draining from the wound

• Arterial bleeding is the most serious due to the

amount and speed of blood loss and is the hardest
to control
• The most important treatment for an open wound
is to stop the bleeding with firm direct pressure
TYPES of BLEEDING
 TYPES of WOUNDS
• LACERATION: cut or torn
• PUNCTURE: usually deep with minimal bleeding,
greatest chance of infection.
• ABRASION: painful scraping away of skin`
• AVULSION: A piece of skin or tissue is completely or
partially torn out of the body.
LACERATED WOUND
PUNCTURED
WOUND
ABRASION
AVULSION
 SEVERE BLEEDING
• Don’t attempt to clean wound at this time
• Remove any clothing over the wound so you can
see where the bleeding is coming from and if there
is anything embedded in the wound
• Apply direct pressure with sterile gauze
• Treat for shock: lay the victim flat on bed or on the
floor and maintain body temperature
• Once the bleeding has stopped use an elastic or
roller bandage to secure dressings in place and
apply pressure.
CONTROL of SEVERE BLEEDING
 POSITIONING A VICTIM
• Generally you should not move a victim unless
there is danger, such a fire, smoke or you need to
provide much needed emergency care.
• For victims of trauma (vehicular accident) or anyone
complaining of head, neck or back pain, you should
stabilize the head and neck and keep the person
calm and still
 UNRESPONSIVE VICTIM
• H.A.IN.E.S. recovery position (High Arm IN
Endangered Spine) when an unresponsive person is
breathing normally and you must leave to get help,
or when fluids or vomit may block the airway.
• This is the best recovery position, If neck or back
injury is suspected
• In modified HAINES position the head is supported
by the victims arms.
HAINES
 RESPONSIVE PATIENT
• Shock position: Patient lying down face up,
elevated lower extremities
Pale face
Cold, clammy skin
Fast, shallow breathing
Rapid, weak pulse
Yawning
Sighing
In extreme cases,

unconsciousness.
SITTING POSITION or HIGH BACK REST
• A person who is
having difficulty of
breathing is usually
comfortable in this
manner.
• A person with
Shortness of Breath
may sit upright
supported by his
arms
 POSITION OF COMFORT
• Help a person that is most comfortable.
• A person can often find the position that reduces
pain, nausea or shortness of breath
 EMERGENCY DRAGS

• Ankle drag
• Shoulder pull
• Blanket drag
• Clothes drag
• Fireman’s drag
ANKLE DRAG
SHOULDER PULL
BLANKET DRAG
CLOTHES DRAG
FIREMAN’S DRAG
 EMERGENCY CARRIES
• Human Crutch
• Pack Strap Carry
• Seat Carry
• Lover’s carry
• Fireman’s carry
 HUMAN CRUTCH
or ASSIST TO WALK
PACK STRAP CARRY
SEAT CARRY
LOVER’S CARRY
FIREMAN’S CARRY
HAMMOCK CARRY OF 3 MAN CARRY