ems safety cpr/aed training emergency response for the home, community and workplace © 2012 ems...

EMS Safety CPR/AED Training

Emergency Response for the Home, Community and Workplace

© 2012 EMS Safety Version B

INTRODUCTION

2CPR/AED for Community Rescuers

What we will learn today

• Quickly recognize an emergency• CPR on an adult victim• CPR on a child and infant victim*• AED use*• Emergency response

– Heart Attack– Stroke– Choking

*Optional Topic

3CPR/AED for Community Rescuers Intro

Certification Requirements

• Sign in on roster• Participate in all course activities • Pass written exam with 80% or more• Pass skills exams• Just FYI…

– Cards are valid for 2 years– Let me know privately if concerns about physical

requirements or any latex allergies– Participation certificates are available


State & Local Requirements

• Guidelines are consistent with other nationally-recognized training organizations

• Follow state, local or workplace guidelines if they differ from this course

• Ask state or local Emergency Medical Services (EMS) Authority about– AED use on infants– Asthma inhalers– Epinephrine auto-injectors– Use of aspirin for heart attack signs and symptoms


CHAIN OF SURVIVAL


Key Concepts

• Leading cause of death in U.S. is Heart Disease

• Heart disease leads to Sudden Cardiac Arrest (SCA)– Heart suddenly stops beating– Person is unresponsive– Breathing stops – Brain damage in 4 – 6 min w/o CPR

• The Chain of Survival is a series of actions that gives SCA victims the best chance of survival

7CPR/AED for Community Rescuers Chain of Survival

5 Steps to SCA Survival

What are the best actions to take immediately after Sudden Cardiac Arrest?

5 Steps to Survival

1. Activate EMS (Call 9-1-1)

2. Early CPR

3. Early Defibrillation

4. Early Advanced Care

5. Post-Arrest Care


Activate EMS (Call 9-1-1)

Use cell phone or land line Activate EMS (Call 9-1-1)

• Recognize cardiac arrest– Not responding– Chest not moving, no

breathing

• Don’t delay: early 9-1-1 linked to increased SCA survival

• Send bystander if possible

• If unsure, go call!


Early CPR

Start compressions! Early CPR

• Start with Chest Compressions

• Compressions restore flow of oxygen to brain

• Good chest compressions linked to increased survival

• Push hard and fast!


Early Defibrillation

Early Defibrillation

• Defibrillators can restart the heart of an SCA victim

• Calling 9-1-1 gets a defibrillator to the scene

• An Automated External Defibrillator (AED) is used by citizen rescuers

• Some public places like airports have AEDs accessible to all rescuers


Use AED when it arrives

Advanced & Post-Arrest Care

Advanced Care• AKA: Advanced Life

Support• Provided by paramedics,

continued at hospital• Adds advanced airway

management, drug therapy, cardiac monitoring to CPR

• Goal: restart heart and stabilize for post-arrest care

Post-Arrest Care• Comprehensive care once

person is stabilized• Begins at hospital and

continues through discharge

• Provided by doctors, nurses, therapists and many others

• Goal: Improve chances of continued survival with least disability


Discussion

1. Why is activating EMS the first link in the chain of survival?

2. Are AEDs located in your community or workplace? Where?

3. Why does the bystander have the biggest impact on survival of SCA?


CPR OVERVIEW


Key Concepts

CPR/AED for Community Rescuers CPR Overview 15

• Cardiac Arrest = – No heartbeat– No oxygen to brain or vital organs

• CPR can:– Keep brain alive– Oxygenate vital organs – Extend the time for successful defibrillation

Cardiopulmonary Resuscitation

Heart is squeezed between sternum and backbone

CPR

• Combines external chest compressions and rescue breathing

• Breaths fill lungs• Compressions move

oxygen by pumping blood• Keeps brain alive• Chest compressions

are most important part


What is an AED

Automated External Defibrillator (AED) What it does…

• Uses voice and visual prompts

• Easily guides rescuers• Analyzes heart rhythm • Determines if shock is

needed• Restores normal rhythm• Provides CPR reminders


Ventricular Fibrillation (V-fib)

V-fib to Shock to Normal V-fib is common in SCA

• Heart overwhelmed by electrical activity

• Can be related to lack of oxygen

• Quickly lethal• Victim unresponsive• CPR won’t stop V-fib• “Defib” is only treatment

for “V-fib”


V-fib present in 90% of SCA cases

How an AED Works

• AED detects V-fib• Sends powerful

current through heart• Shock resets heart’s

electrical activity• Heart may start

beating normally• Like a ‘control-alt-

delete’ for the heart


Power on & attach pads

Sum it Up

• CPR restores flow of oxygen to the brain• CPR can extend time for successful AED use• The sooner an AED is used, the more likely it will

work


C-A-B

The C-A-B sequence applies to victims of all ages. Learn the adult sequence first…

CPR/AED for Community Rescuers 21

Key Concepts

• C-A-B stands for: – Compression – Airway– Breathing

• Best sequence of rescuer actions for CPR– In first few minutes victim’s body still has oxygen-rich

blood– Starting with chest compressions circulates oxygen,

eliminating need to start with rescue breaths

• The C-A-B sequence is used for unresponsive victims of all ages

CPR/AED for Community Rescuers C-A-B 22

Establish Response, Check Breathing

Hey! Are you okay? Tap and shout

• If no response– Go call 9-1-1– Get an AED if available– Send bystander if present

Scan the chest for breathing, 5-10 seconds• If no breathing or only

gasping:

START COMPRESSIONS


C: Compressions

Push Hard & Fast! Provide 30 Compressions

• Use a firm, flat surface• Center of the chest,

between nipples• Push hard: At least 2”• Push fast: At least 100

compressions per minute• Ensure full recoil: Chest

expands between each compression

• Minimize interruptions


A: Airway

Prepare for rescue breaths Quickly Open Airway

• Position head using the head tilt/chin lift

• Place 1 hand on forehead• Place 2 or 3 fingers of

your other hand near the chin

• Tilt the head back while lifting the jaw upward


B: Breathing

Give breaths carefully… 2 Rescue Breaths

• About 1 second per breath• Maintain head tilt/chin lift• Pinch nose• Seal the victim’s mouth with

yours or use barrier• Breathe into the mouth for

about 1 second• Watch for chest rise• Lift mouth off• Repeat for 2nd breath


Too much air causes vomiting

Repeat the C-A-B Sequence

• Take < 10 seconds to give 2 breaths• Quickly resume chest compressions after giving

rescue breaths• Continue repeating the sequence of 30

compressions, open airway, give 2 breaths• CPR is performed in cycles

– 1 cycle is 30 compressions and 2 breaths (30:2)– 5 cycles of CPR can be performed in about 2 minutes


When to Use the AED

Use AED when it’s available If 2nd Rescuer Present

• Rescuer 1 continues CPR• Rescuer 2 operates AED• Switch roles when the AED

prompts to stop CPR– If no AED, switch performing

CPR about every 2 minutes

• Observe CPR provider & give feedback

• Pushing hard/fast enough?


Recovery Position

If breathing normally…Modified H.A.IN.E.S Recovery Position

• Use when – Need to leave to get

help– Victim vomits


Place victim on side

Discussion

• Could I really do it?


Sum It Up

• Starting CPR with chest compressions circulates the oxygen still in the blood and gives the victim the best chance of survival

• Quality compressions matter• Push hard and fast• Minimize interruptions to compressions

– No more than 10 seconds to give breaths

• Allow the chest to fully recoil (expand) between each compression– Take your weight off the victim’s chest


CPR BARRIERS


Key Concepts

• The risk of catching a disease with rescue breaths is extremely low

• It is common to be uncomfortable with the thought of giving mouth-to-mouth rescue breaths

• CPR barriers can help prevent exposure to blood or body fluids

• Create a barrier between the victim and rescuer while allowing for the passage of air

CPR/AED for Community Rescuers CPR Barriers 33

CPR Face Mask

• May require quick assembly

• Covers mouth and nose• Prevents back flow of

exhaled air or fluids• Select the correct size:

– Base (wide end) does not extend past chin

– Top (narrow end) does not extend past bridge of the nose


Molded plastic mask

Using a Face Mask

1. Press mask onto face

2. Lift the chin to open the airway

3. Breathe into the mask

4. Watch for chest rise with each breath


CPR Face Shield

• Fits over the mouth• Pinch the nose over

or under the face shield

• Stored in keychain pouch with gloves

• Close to rescuer at all times


Small, flexible plastic with a filter or valve

Using a CPR Face Shield

1. Place over face with filter or valve over person’s mouth

2. Open airway

3. Pinch nose

4. Breathe into the filter or valve

5. Watch for chest rise with each breath


USING AN AEDOptional Segment, only required for AED certification…


Optional Topic

Key Concepts

• AEDs can be used on adults, children and infants

• An AED has a status indicator to show if it is ready for use

• Follow local protocols for age-specific AED guidelines if they differ from this course

• Basic AED Sequence:– Power on the AED– Apply pads– Follow AED prompts

CPR/AED for Community Rescuers Using an AED 39

Power the AED

• Place AED near head• Power on AED• AED guides actions


Apply AED Pads

• Expose chest– Cut clothing– Wipe dry

• Apply pads (follow pictures)– Right upper chest, just

below collarbone– Lower left side of the

chest

• If 2 rescuers– Rescuer 1 continues

CPR– Rescuer 2 operates

AEDCPR/AED for Community Rescuers Using an AED 41

Shock or No Shock?

• After pads are applied:– AED prompts rescuer to stop CPR– AED analyzes the heart’s electrical rhythm– Do not touch or move the person

• AED will state ‘shock advised’ or ‘no shock advised’

• If no shock advised, AED will prompt rescuer to resume chest compressions

• If shock advised, rescuer must clear victim first


Clear Victim and Shock

• Clear victim first– Loudly state, “Clear!”– Look up and down entire

victim– Ensure no one touching

person or clothing

• Press shock button– Some AEDs shock

automatically (no button)– AEDs announce when

safe to resume compressions


Do not touch victim or clothing during a shock

Resume CPR

• Start with chest compressions

• AED will analyze heart rhythm every 2 minutes

• If 2nd rescuer present– Switch roles when AED

prompts to stop CPR– One rescuer rests– Other rescuer gets in

position for CPR– Rescuer 2 will continue

to operate AED


Immediately resume CPR

AED Use on Children

• Children & infants require less electrical current

• Special equipment reduces amount of energy delivered– Child/Infant Pads– Energy reducer or

attenuator– Pediatric key or switch

• If pediatric equipment is not available, use standard equipmentCPR/AED for Community Rescuers Using an AED 45

For AED use:A child is 1-8 years old, or less than 55 lbs.An infant is < 1 year old

For Smaller Children or Infants


• Use front-to-back AED pad placement if needed

• Pads should not touch or overlap• Do not cut or fold pads to fit

ADULT CPR

In CPR, a victim is considered an adult when signs of puberty are present. Look for facial or underarm hair on a male or signs of breast development on a female.


Key Concepts

• Always check the scene for safety first• If the scene is safe, establish a response• If unresponsive and not breathing or only

gasping, provide CPR using the C-A-B sequence

CPR/AED for Community Rescuers Adult CPR 48

Starting CPR

• Survey scene, size-up potential hazards

• Tap the shoulder and shout, “Are you all right?”

• Call 9-1-1, get AED– Send bystander– Go yourself if alone

• Scan chest for breathing (5-10 seconds)

• Start compressions if no breathing, only gasping, unsure if breathing


C: 30 Compressions

• Expose chest if needed• Location: center of the

chest, between nipples• Use 2 hands:

– Heel of one hand on chest– Heel of other hand on top

• Push hard: At least 2” down• Push fast: At least 100 per

minute• Ensure full recoil• Minimize interruptions


Use a firm, flat surface

A: Open Airway

• Place 1 hand on the forehead – Apply firm, backward

pressure with your palm– Tilt head back

• Place 2 or 3 fingers of other hand near chin – Keep fingers on bony

part of the jaw

• Tilt the head back, lift the chin forward


B: Give 2 Breaths

• Maintain head tilt/chin lift

• Pinch the nose• Breathe into mouth

for about 1 second• Watch for chest rise• Repeat for the 2nd

breath• Do not over-ventilate


Continue CPR

• If 2 rescuers, switch roles every 2 min (5 cycles) or when AED is analyzing– Rest between roles as CPR

provider– Keep provider on pace (at

least 100 comp/min)– Instruct compressor to push

harder (at least 2”) if too shallow

• Only Stop CPR if– Victim begins to move– EMS responders take over– AED prompts you to stop


Cycles of 30:2

Defibrillation

• Use when available• Place near victim’s

head• Power on AED• Follow prompts• Apply pads• Press shock button• Resume compressions

after shock


Discussion

1. What is the best way to activate EMS at home? At work?

2. What do you do if the chest won’t rise with the 1st rescue breath?

3. What is the most important part of CPR: compressions, airway management, or rescue breathing?


CHILD CPR In CPR, a victim is considered a child from age 1 until puberty.


Key Concepts

• Usually different cause of cardiac arrest for children and infants than for adults– Adults: Heart disease, heart attack– Children/infants: Respiratory arrest

• Common causes of respiratory arrest in children:– Injury– Poisoning– Choking– Drowning– Asthma

CPR/AED for Community Rescuers Child CPR 57

Starting CPR


• Tap the shoulder and shout, “Are you all right?”

• Send bystander to call 9-1-1, get AED

• Stay with the child• Scan the chest for

breathing, 5-10 seconds• Start compressions if no

breathing, only gasping, if you’re unsure


If alone, yell for help. Stay for 2 minutes of CPR before leaving to call 9-1-1

C: 30 Compressions

• Expose chest if needed• Location: Center of the

chest, between nipples• Use 1 or 2 hands• Push hard: About 2”

down• Push fast: At least 100

per minute• Ensure full recoil• Minimize interruptions



A: Open Airway


pressure with your palm

– Tilt head back• Place 2 or 3 fingers

of other hand near chin – Keep fingers on bony

part of the jaw• Tilt the head back,

lift the chin forwardCPR/AED for Community Rescuers Child CPR 60

B: Give 2 Breaths


• Pinch the nose• Breathe into mouth

for about 1 second• Watch for chest rise• Repeat for the 2nd



Continue CPR

• If 2 rescuers, switch roles every 2 minutes (5 cycles)– Rest between roles

as CPR provider– Keep provider on

pace (at least 100/min)

– Instruct compressor to push harder if too shallow


Cycles of 30:2

Call 9-1-1

• Return quickly• Resume CPR until

EMS takes over or the child begins to move

• Use an AED as soon as it is available


If still alone after 2 minutes, go activate EMS and get an AED if one is close by

INFANT CPR In CPR, a victim is considered an infant up to1 year old.


Key Concepts

• Common causes of respiratory arrest in infants:– Choking– Injury – Sudden Infant Death Syndrome (SIDS)– Respiratory illness

CPR/AED for Community Rescuers Infant CPR 65

Starting CPR


• Tap bottom of foot and shout

• Send bystander to call 9-1-1, get AED

• Scan the chest for breathing, 5-10 seconds

• Start compressions if no breathing, only gasping, or if you’re unsure


If alone, yell for help. Stay for 2 minutes of CPR before leaving to call 9-1-1

C: 30 Compressions

• Expose chest if needed• Location: Center of chest,

just below nipple line• Use 2 fingers• Push hard: About 1½”

down• Push fast: At least 100

per minute• Ensure full recoil• Minimize interruptions



A: Open Airway


pressure with your palm– Tilt head back

• Place 2 or 3 fingers of other hand near chin

• Tilt the head back, lift the chin forward

• Maintain a neutral or slightly extended position


Do not tilt the head too far back. Overextending the airway can actually close it!

B: Give 2 Breaths


• Breathe into mouth and nose about 1 second

• Watch for chest rise• Repeat for the 2nd



Breathe into mouth and nose at the same time

Continue CPR

• If 2 rescuers, switch roles every 2 minutes (5 cycles)– Rest between roles as

CPR provider– Keep provider on pace

(at least100/min)– Instruct compressor to

push harder if too shallow


Cycles of 30:2

Call 9-1-1

• Take the infant with you if you have to leave

• Resume CPR until EMS takes over or the infant begins to move

• Use an AED as soon as it is available


If still alone after 2 minutes, call 9-1-1

SPECIAL CONSIDERATIONS - CPR


Key Concepts

• Certain situations may affect response to cardiac arrest

• Keep CPR going as long as possible• In cold environments

– A hypothermic victim may have more time before brain damage occurs

– Do not assume it is too late to begin CPR

• Electrical shock may cause immediate respiratory or cardiac arrest– Scene safety is most important– Shut off the power source first

• Make sure scene is safe before approaching victim

CPR/AED for Community Rescuers Special Considerations - CPR 73

Vomiting

• A person in cardiac arrest will often vomit from over-ventilation

• If the victim vomits, roll person to side, sweep out mouth, roll back, continue CPR

• Reduce risk with rescue breaths by providing just enough air to cause the chest to rise


When to Stop CPR

• Victim begins to move or breathe

• AED directs you to stop• Scene becomes unsafe• Physically exhausted and

unable to continue• Professional rescuers

arrive and are ready to take over

• Victim is pronounced dead by a qualified person


Compression-only CPR

• Continuous chest compressions without rescue breaths

• Exchange of oxygen occurs with the force of compressions

• Taught by dispatchers to untrained rescuers who call 9-1-1

• Also used for adult victim if rescuer is unable or unwilling to provide rescue breaths


Only for adult victims

Nose and Stoma Rescue Breathing

Mouth-to-Nose

• Use if victim’s mouth or jaw is severely damaged

• Holding mouth closed prevents air from escaping

• Make a seal and exhale into victim’s nose

Mask-to-Stoma

• Stoma: surgical opening at base of throat

• Can be performed with mask or mouth-to-stoma

• Pinch nose closed if possible to prevent air escape

• Make a seal around the stoma and exhale; watch for chest rise


SPECIAL CONSIDERATIONS - AED

Optional segment, only required for AED certification

78

Optional Topic

Key Concepts

• There are 3 situations to consider when applying AED pads that may alter rescuer’s actions: – A very hairy chest– An implanted device (e.g. pacemaker)– A medication patch

CPR/AED for Community Rescuers Special Considerations - AED 79

Very Hairy Chest

• A lot of chest hair limits contact between AED pad and victim’s skin

• AED may not be able to read heart rhythm

• If the first set of pads is not working– Press pads firmly onto

skin– Remove with a quick

motion– Apply second set of pads


If only 1 set of pads is available, quickly shave the areas of pad placement before applying pads

Implanted Devices

• Devices may include− Pacemaker− Automated Implantable

Cardioverter-Defibrillator (AICD)

− Medication administration port

• Most implanted devices do not affect AED pad placement.– Do not place pad directly

over implanted device– Adjust pad placement at

least 1” from device


Device may appear as a small raised lump under skin

Medication Patches

• Do not place an AED pad over a medication patch– Use a gloved hand to

remove the patch– Quickly wipe chest

clean with a towel or cloth

• Apply pads after area is wiped clean


Medication can be embedded in an adhesive patch applied to skin

Storage & Maintenance

• Close to trained rescuers– Near most of people, most of the

time– Visible signage; easy access– Common areas easy to describe

• With accessories– Spare adult pads– Pediatric pads or adaptor– CPR barrier, gloves– Safety razor– Absorbent towel

• Inspection– Status indicator shows ‘Ready’– Pads & battery not expired– No visible damage– No missing accessoriesCPR/AED for Community Rescuers Special Considerations - AED 83

Troubleshooting

• An AED performs self checks regularly and every time it is powered on.

• The AED will notify operator if problem detected• “Check pads”

– Press down firmly, or replace pads w/ back up set– Check pad connection to AED

• “Low Battery”– Replace battery– Even in low battery state, AED may provide several shocks– Refer to AED manufacturer for more information

• Movement– Disrupts analysis of heart rhythm– When AED is analyzing, do not touch or move victim


Sum It Up

• Consider shaving a very hairy chest before pad placement

• Avoid placing pads over implanted device• Remove medication patches• Store AED near trained rescuers and a phone• If a problem with AED cannot be quickly solved,

discontinue AED use and resume CPR


AED SAFETYOptional segment, only required for AED certification

86

Optional Topic

Key Concepts

• Using an AED during an emergency is safe

• Take precautions to maximize safety• Consider rescuer’s actions when:

– Clearing the victim– Water is present– The victim is using oxygen

CPR/AED for Community Rescuers AED Safety 87

What is Wrong With This Picture?


Water

• If victim is lying in puddle of water– Move to a dryer area– Ensure rescuers not standing

in water

• Water on victim’s chest can interfere with defibrillation– Quickly dry chest before

applying pads– A wet chest may cause

electricity from AED to disperse before reaching heart

• Good pad contact with dry skin provides more effective and directed shock to heart


How would you make this scene safe for AED use?

Wipe chest dry before applying pads

Oxygen

• Medical oxygen is combustible

• If a person is wearing oxygen– Turn it off or remove the

mask or cannula

• If oxygen is being used with rescue breaths – Move it several feet from

victim before shock– Resume rescue breaths

with supplemental oxygen


Some people may use oxygen at home or out in community

Discussion: How would you REACT?

• Instructor-led discussion• Review workbook questions• Discuss at least 1 scenario

CPR/AED for Community Rescuers REACT Discussion 91

RESPONDING TO EMERGENCIES


Key Concepts

• Emergency scenes can be dangerous• Rescuers can quickly become victims• Caution and common sense can save your life

CPR/AED for Community Rescuers Responding to Emergencies 93

R.E.A.C.T to an Emergency

• R: Recognize Emergency• E: Environment Safety and Size-Up• A: Assess Victim• C: Call for Help• T: Treat Victim


Recognize Emergency

• Screams, panic; seriously ill or injured person; victim or bystanders agitated or threatening

• Suspicious environment; collision or stopped vehicle; environmental hazard

• Remain calm; stay aware of your own safety

• Consider resources and options


Environment Safety

• Size-up the scene from a safe distance– Blood and body fluids: Use personal protective equipment– Traffic: Use car to protect scene; use bystanders to stop traffic– Fire or smoke: Do not enter; focus on escape; stay low– Hazardous chemicals: Leave the area immediately– Confined space: Do not enter! – Hostile environment: Do victim or bystanders appear agitated or

threatening? • Size-up the victim

– How many? – What is their general condition?– Identify cause of illness or injury– If more than 1 victim, decide who needs help most. If unsure,

help person closest to you. • Activate EMS now if the scene is dangerous or if there is

an obvious life-threatening injury or illness.


Assess Victim & Call for Help


• Assess the victim– Go to the victim’s side – Assess response and

breathing – Life-threatening illness or

injury

• Call for help– Shout for help– Call 9-1-1 or your emergency

response #

• If not sure it’s an emergency?– Activate EMS – Dispatcher will ask questions

to determine if an emergency

Treat Victim

• Treat life-threatening conditions first– If no breathing or only

gasping, begin CPR– If severe bleeding, control

with direct pressure

• Treat victim in position found

• Only move victim if– Danger– Need to position for

essential care


Calling 9-1-1

• When you call 9-1-1, dispatcher will ask– Name, location, call back phone #– What happened– Number of victims and general condition – What aid is being given

• Follow instructions, and always hang up last• When EMS responders arrive

– Continue care until told to stop– Tell EMS what time event occurred, what time you

arrived, and what care has been given


Rescuer Stress

• Normal to feel stress after incident

• Each rescuer responds differently to stress

• Don’t ignore post-traumatic stress, manage it– Talk about your feelings– Eat properly– Avoid alcohol, drugs, caffeine– Exercise– Get enough rest

• Don’t judge yourself for your actions


Obtain professional help if needed

LEGAL ISSUES


Key Concepts

• Some people have a duty to respond to an emergency

• Other people respond voluntarily• Voluntary responders are protected by the Good

Samaritan Law• Maintain skills to stay informed on current

practices

CPR/AED for Community Rescuers Legal Issues 102

Good Samaritan Law

• Respond voluntarily• Not getting paid to

respond• Provide care with good

intentions• Stay within limits of

training• Not reckless or careless• Do not abandon victim

after beginning care


Protects voluntary responders from civil liability

Gaining Consent

• State name, training, & care plan• Ask if you can help• Types of Consent

– Expressed: expresses desire for aid– Implied: unresponsive person,

unattended minor– Minor’s consent: A parent or legal

guardian gives consent

• Right to Refuse Care– Can refuse care at any time– Observe situation from a distance,

call 9-1-1 if needed

• Right to Privacy– Do not give out information to

coworkers or bystanders– Give information to EMS responders

and to supervisor


Get consent from victim before beginning care

PROTECTION FROM INFECTION


Key Concepts

• The OSHA Bloodborne Pathogens Standard requires the employer to help protect you from exposure to BBP

• Use precautions with every emergency• Hand washing is an important part of infection

control

CPR/AED for Community Rescuers Protection from Infection 106

Bloodborne Pathogens

• Most serious: – HIV – Hepatitis B – Hepatitis C

• May be transmitted during an emergency when – Giving first aid – Handling contaminated

sharps– Cleaning a blood spill

• Routes of transmission– Splash to eye, mouth or nose– Opening in skin (cut, scab,

rash, hangnail)


Bloodborne pathogens are disease-causing microorganisms in blood

Universal Precautions

• Assume all blood and body fluids are infectious, except sweat

• Take precautions with all victims, even children

• Use personal protective equipment– Disposable gloves– Gown– Mask, goggles or face mask – CPR barrier

• Wash hands thoroughly immediately after glove removal

• If no water, use hand sanitizer, then wash ASAP


What To Do If You’re Exposed

Follow Exposure Control Plan Hand Washing Technique

• Wash hands and any exposed area as soon as possible

• Use soap and warm water

• Scrub thoroughly for at least 20 seconds

• Rinse well


• Immediately remove gloves• Wash thoroughly with soap

and water

Removing Soiled Gloves

1. Pinch base of glove, peel off slowly, hold in other hand

2. Slip 1 or 2 fingers inside other glove, carefully peel off so that it is inside out

3. Dispose in proper, leak-proof container


Cleaning After an Emergency

• Clean spill with paper towels or an absorbent powder

• Pick up sharp objects or broken glass with tongs or brush and dustpan

• Disinfect with 10% bleach and water or another disinfectant

• Dispose of soiled personal protective equipment according to workplace policy

• Wash your hands


Wear personal protective equipment

Airborne Pathogens

• Other diseases can be spread when an ill person coughs or sneezes

• Protect yourself by:– Getting a flu vaccine– Washing your hands often– Avoiding contact when possible with people who may

be contagious


Sum it Up

• Keep first aid kits stocked with personal protective equipment

• If you don’t have personal protective equipment with you, use whatever is available:– e.g. To control bleeding, have the victim apply the

pressure, or use layers of clean cloth or extra gauze


HEART ATTACK


Key Concepts

• Heart disease is leading cause of death in the U.S.

• Heart attack can lead to cardiac arrest• More than 1.25 million Americans have a first or

recurrent heart attack every year• About 70% of the deaths from heart attack occur

before the victim reaches the hospital• Call 9-1-1 early for any signs of heart attack

CPR/AED for Community Rescuers Heart Attack 115

What is a Heart Attack?

• Coronary Artery Disease– Build-up of fatty deposits in

blood vessels– Coronary arteries narrow &

harden over years– Vessels become blocked– CAD is preventable

• What is a heart attack?– Heart pumps blood throughout

the body– Coronary arteries deliver

oxygenated blood to heart– A blocked coronary artery

deprives the heart of oxygen– Results in death of heart

muscleCPR/AED for Community Rescuers Heart Attack 116

Heart Attack Signs & Symptoms

• Chest discomfort– Pain, pressure, tightness, squeezing, fullness– Discomfort may radiate to the arms, neck, back, jaw,

or abdomen– Often mistaken for heartburn or indigestion

• Pale, cool, sweaty skin• Shortness of breath• Dizziness, fainting or unresponsiveness• Nausea, vomiting• Unexplained fatigue


Emergency Care for Heart Attack

1. Call 9-1-1, get AED if available

2. Position of comfort, usually sitting

3. Calm, reassure person

4. Offer 1 adult or 2 baby aspirin for victim to chewa. No allergy to aspirin, signs of stroke, or recent

bleeding problems

b. Make sure victim is alert and can swallow

5. Check breathing if victim becomes unresponsivea. If no breathing or only gasping, begin compressions

b. Use the AED when it arrives


Don’t Delay Calling 9-1-1

• If any signs and symptoms are present• If the symptoms fade and return• To give aspirin• Calling 9-1-1 can mean difference between heart

attack & cardiac arrest• Professional Rescuers can provide treatment

before cardiac arrest occurs


Unusual Symptoms

• Be alert to other symptoms– Extreme fatigue– Nausea, vomiting– Shortness of breath– Pain in jaw, neck, arm(s)

or abdomen

• Women are as likely to have a heart attack as men

• May not report symptoms• Often misdiagnosed


Women, diabetics, elderly may not have classic ‘chest discomfort’

Use of Aspirin

• Chewing aspirin gets it into the bloodstream faster than swallowing it

• Aspirin thins blood, reduces ability to clot

• Ensure no allergy to aspirin, signs of stroke, or recent bleeding problems

• Victim must be alert and able to swallow


Learn your state, local & workplace guidelines for use of aspirin.

Offer 1 adult or 2 baby aspirin for victim to chew

STROKE


Key Concepts

• Stroke is 3rd leading cause of death in U.S.• 800,000 strokes each year in the U.S.• Call 9-1-1 early for any signs of stroke

CPR/AED for Community Rescuers Stroke 123

What is a stroke?

• A stroke is like a heart attack occurring in the brain

• Caused by a clot or bleed in the brain• Symptoms may be minor or severe• Many survivors are permanently impaired

and struggle with daily activities


Stroke Signs & Symptoms

• Sudden onset• Weakness or numbness of arm or leg, usually on

one side of body• Facial droop or paralysis• Difficulty speaking• Difficulty eating, swallowing, or managing secretions• Loss of balance or coordination, difficulty walking• Confusion, anxiety, unresponsiveness• Changes in sensation• Severe headache or dizziness• Change in vision• Temporary symptoms may be a baby stroke


Emergency Care for Stroke

1. Call 9-1-1 (activate EMS)

2. Protect the airwaya. Place in the recovery position to allow fluids to drain

if needed

3. Calm and reassure victim

4. Note time that symptoms began

5. If person is unresponsivea. Check for breathing

b. Start compressions if needed


Don’t Delay Calling 9-1-1

• Call 9-1-1 immediately for signs of stroke• Do not wait to see if symptoms go away• Do not drive to hospital• The time it takes to call 9-1-1 is critical

– Some strokes treated with clot-busting medication (fibrinolytic therapy)

– Same as with a heart attack– Only effective in the first few hours of a stroke

• Early recognition of stroke can make difference between life and death or between complete recovery and lifelong disability


STR: Smile, Talk, Reach Assessment


• Smile: Ask person to smile. – Look for uneven smile or

facial droop

• Talk: Ask person to repeat a common phrase. – Listen for slurred or

incorrect words

• Reach: Ask person to close eyes and raise arms. – Look for arm drift or

weakness on one side

ADULT OR CHILD CHOKING


Key Concepts

• Choking is a preventable emergency• Most choking incidents occur in children younger than 5

years old• Treatment is the same for an adult or child• Act quickly! Severe choking results in death if not treated• Differentiate between choking and other emergencies

(heart attack, asthma, seizure, drug overdose)• Was person

– Talking or drinking alcohol while eating– Eating too fast or not chewing food completely– Wearing dentures while eating (hard to tell if food is chewed)– Walking or running while eating or chewing gum

• Universal sign of choking: 1 or both hands at throat

CPR/AED for Community Rescuers Adult/Child Choking 130

Mild Obstruction

• If person can forcefully cough or speak, do not interfere

• Forceful coughing is the best way to relieve an obstruction

• Ask, “Are you choking?”– If can cough or speak,

encourage coughing– Watch for progression to

severe obstruction

• Send someone to call 9-1-1 if coughing is prolonged


Airway is partially blocked

Severe Obstruction

• Use abdominal thrusts• Ask, “Are you choking?” • If nods or can’t speak:

1. Say you are going to help

2. Stand behind person & reach under arms

3. Place 1 fist just above navel, thumb side in

4. Grasp fist with other hand

5. Give quick upward thrusts until object comes out or the person can breathe or cough

6. Send bystander to call 9-1-1 if cannot quickly clear obstructionCPR/AED for Community Rescuers Adult/Child Choking 132

Airway is completely blocked and person cannot breathe

Unresponsive Choking Person

• Lower person to ground• Send a bystander to call

9-1-1• If alone with adult victim,

go call 9-1-1 now• Perform CPR• Look in mouth after each

set of compressions– If object is seen, remove it– Do not ‘blind sweep’ mouth

• If alone with a child or infant, go call 9-1-1 after 2 min. of CPR


Pregnant or Larger Victim

• Stand behind person• Reach around chest,

under arms• Place one fist in center

of the chest– Same location as chest

compressions

• Grasp fist with other hand

• Perform continuous backward thrusts


Use Chest Thrusts

Choking Prevention Tips

• Eat slowly and chew food completely• Do not talk or laugh with food in your mouth• Adults: Don’t drink too much alcohol while

eating; make sure dentures fit well• Children: Cut food into small pieces; cut round

food into halves or quarters• Protect young children from objects small

enough to fit through center of toilet paper roll• Keep children seated and supervised at

mealtime


INFANT CHOKING


Key Concepts

• Choking is a preventable emergency• Most choking incidents occur in children younger

than 5 years old• Treatment for infants is different than for adults

and children

CPR/AED for Community Rescuers Infant Choking 137

Signs of Infant Choking

• Signs of Choking– Unable to cry or cough effectively– Difficulty or no breathing– Wheezing or high-pitched sounds– Bluish color skin– Bulging or tearing eyes– Panic or distressed facial expressions

• Mild Obstruction: Infant able to cough or cry– Do not interfere– Observe for progression to severe obstruction– Do not leave the infant– Call 9-1-1 if unsure


Severe Obstruction

• Send bystander to call 9-1-1– Stay with infant if alone

• Sit or kneel• Hold face down &

provide 5 back slaps• Turn face up & provide

5 chest thrusts• Repeat sequence until

relieved or unresponsive


Unresponsive Choking Infant

1. Use CPR to remove object

2. Send bystander to call 9-1-1

3. Perform CPR with added step of looking in mouth after compressions

4. Continue CPR until infant begins to breathe

5. Call 9-1-1 after 2 minutes if still alone


Discussion: How would you REACT?

• Instructor-led discussion• Review workbook questions• Discuss at least 1 scenario

CPR/AED for Community Rescuers REACT Discussion 141

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