Ld 34 - First Aid

Front 1

EMS

Back 1

Emergency Medical Services

Front 2

Peace officer primary responsibilities as first responder

Back 2

As first responders, peace officers should assume the primary responsibility for:
• ensuring peace officer safety as well as the safety of ill or injured individuals and the public
• evaluating the emergency situation
• taking necessary enforcement actions related to the incident
• initiating actions regarding the well-being and care of ill or injured persons

Front 3

En route to the scene

Back 3

The primary objective of all peace officers responding to any emergency call should be to get to the location as quickly and safely as possible.

Front 4

Scene size-up

Back 4

At the scene peace officers should evaluate the nature of the incident and communicate critical information to dispatch and other involved units as soon as possible.

• Location

- Exact address or location of the incident
- Conditions present at the scene
- Potential hazards related to the incident or the area

• Type of emergency

• Nature of ill/injured persons

• Need for additional resources

• Urgent enforcement actions required

- Protection of victim(s) from aggressor(s)
- Control of suspect(s) and/or bystanders
- Immediate protection of a crime scene

Front 5

Safety precautions

Back 5

When determining appropriate safety precautions to take, peace officers should consider possible dangers from:
• exposure to biological hazards (e.g., body fluids such as blood, saliva, etc.)
• armed suspects, angry bystanders, etc.
• unsafe scene conditions (e.g., unstable buildings, nearby vehicle traffic, etc.)
• environmental hazards (e.g., fire, exposure to dangerous chemicals, chance of explosion, etc.)
• animals (e.g., pets, wild animals)

Front 6

Assessment and care of victim

Back 6

• Based on this initial assessment, peace officers may be required to provide basic care for the victim.

• Such care may include providing basic emergency medical services (EMS) until relieved of the responsibility by other personnel with equal or higher levels of training.

Front 7

Law enforcement actions

Back 7

If the care and well-being of the victim has been turned over to other EMS personnel, peace officers may be required to continue additional enforcement actions including:
• documenting their initial observations when first arriving at the scene
• maintaining control of the scene to protect potential evidence
• identifying and isolating witnesses and involved parties
• recording statements or information provided by the victims, witnesses, etc.
• noting whether items were moved in order to render medical emergency services (e.g., recording what was touched and by whom)
• any other investigative actions required

Front 8

Pathogens

Back 8

Infection and disease are caused by pathogens that are spread through the air or by contact with another person’s blood or body fluids.

Front 9

Bacteria

Back 9

• Bacteria are microscopic organisms that can live in water, soil, or organic material, or within the bodies of plants, animals, and humans.

• Only when a bacteria is harmful would it be considered a pathogen.

Front 10

Virus

Back 10

• A virus is a submicroscopic agent that is capable of infecting living cells.

• Once inside the cells of plants, animals, or humans, viruses can reproduce and cause various types of illness or disease.

Front 11

2 primary methods of transfer of pathogens

Back 11

• Airborne

• Blood borne

Front 12

Airborne pathogens

Back 12

• Airborne pathogens are spread by tiny droplets sprayed during breathing, coughing, or sneezing.

• Airborne pathogens can be absorbed through the eyes or when contaminated particles are inhaled.

Front 13

Blood borne pathogens

Back 13

Blood borne pathogens may be spread when the blood or other body fluids (e.g., semen, phlegm, mucus, etc.) of one person comes into contact with an open wound or sore of another

Front 14

Chain of transmission

Back 14

Chain of transmission is how pathogens are spread such as:
• Infectious agent (bacteria, viruses, fungi, and parasites)
• reservoir
• portal of exit
• mode of transmission
• portal of entry
• susceptible host

Front 15

Exposure

Back 15

• Because of the nature of their occupation, peace officers are at a high risk of being exposed to both airborne and blood borne pathogens.

• NOTE: Exposure does not necessarily mean an individual will contract the illness

Front 16

Personal protective equipment

(PPE)

Back 16

• By using personal protective equipment (PPE), EMS personnel can break the chain of transmission and prevent possible exposure and infection.

• Equipment to be effective, must be used and cared for properly.

• Dispose of properly.

Front 17

Types of PPE

Back 17

• Protective gloves

- vinyl/non-latex (some allergic to latex)

- single use

- put on before contact

- change between victims

• Eye protection

• Masks

• Gowns

• Ventilation devices (portable pocket masks and one-way valve filters)

• General supplies and equipment

- cleaning solutions/disinfectants

- antimicrobial wipes

- puncture resistant disposable containers

- biohazard disposable bags

NOTE: Penal Code Section 13518.1 requires that law enforcement agencies provide peace officers with appropriate portable masks and instruct officers on the mask’s proper use.

Front 18

UNIVERSAL PRECAUTIONS

Back 18

• Treat all body fluids as if they are contaminated!
• If possible, wash hands thoroughly with warm water and antiseptic soap before and after each exposure, even when gloves are worn
• Use hand sanitizer if hand washing is not available
• Use proper cleaning procedures to disinfect and decontaminate any equipment that may have been exposed (e.g., vehicle steering wheel and interior, firearm, radio, etc.)
• Use extra caution when handling broken glass or sharp objects
• Use band-aids or other cover protections when open cuts or sores exist

NOTE: A solution of one part bleach and ten parts water can be used when disinfecting equipment except leather.

Front 19

Personal preventive measures

Back 19

• Peace officers should also be aware of personal preventive measures they may take to remain healthy and support their own immune systems.

• Staying in good physical condition can help breach the chain of transmission of pathogens to which they may be exposed

Front 20

Documentation to exposure

Back 20

If a peace officer is exposed to an infectious pathogen (or even suspects exposure), no matter how slight, that officer should report the exposure verbally and in writing as soon as possible.

Front 21

Responsibility to act

Back 21

As trained professionals, peace officers have a responsibility to:
• assess emergency situations
• initiate appropriate emergency medical services within the scope of the officer’s training and specific agency policy

A peace officer is not required to render care when reasonable danger exists (e.g., while under fire, exposure to hazardous materials, etc.).

Front 22

Immunity from liability

Back 22

The California Legislature has declared that emergency rescue personnel qualify for immunity from liability from civil damages for any injury caused by an action taken when providing emergency medical services under certain specified conditions. (Health and Safety Code Section 1799.102)

To be protected from liability for civil damages, emergency rescue personnel must:
• act within the scope of their employment
• act in good faith
• provide a standard of care that is within the scope of their training and specific agency policy

Front 23

Negligence

Back 23

• If peace officers attempt to provide emergency medical services beyond the scope of their training, or if they act in a grossly negligent manner, they can be held liable for any injuries they may cause.

• Failure to provide care, even though the peace officer has had the appropriate level of training to do so, may also lead to the officer being liable for any injuries caused because of lack of care (e.g., not providing CPR to a victim who is HIV positive).

• NOTE: Peace officers are responsible for complying with their agency policies regarding providing emergency medical services.

Front 24

Expressed consent

Back 24

Peace officers should clearly identify themselves and ask for consent to administer emergency medical services. Consent (i.e., permission) must be obtained from the ill or injured person before providing emergency care.

In order to give lawful consent, the ill or injured person must be:
• conscious and oriented
• mentally competent enough to make rational decisions regarding their well-being
• 18 years or older, or an emancipated minor

Front 25

Implied consent

Back 25

Implied consent is a legal position that assumes that an unconscious or confused victim would consent to receiving emergency medical services if that person were able to do so.

Emergency rescue personnel have a responsibility to administer emergency medical services under implied consent whenever a victim is:
• unconscious
• incapable of giving consent due to a developmental, emotional, or mental disability
• in an altered mental state due to alcohol, drugs, head injury, etc.
• a juvenile, and the parent or guardian is not present

NOTE: Whenever implied consent is assumed or if medical services are provided based on the seriousness of the victim’s condition, emergency rescue personnel should carefully document the conditions or the basis for their decision to treat the victim.

Front 26

Refusal of care

Back 26

A conscious and competent adult has the right to refuse any emergency medical services offered by emergency rescue personnel.

The refusal must be honored as long as the person is mentally competent.

An individual who refuses emergency medical services may be required to sign a release form relinquishing EMS personnel of responsibility for that individual

Front 27

Life-threatening conditions

Back 27

If it is determined that an illness or injury is such that if left untreated the victim’s condition will degenerate to a life-threatening condition, the emergency rescue personnel may provide medical services regardless of the victim’s conscious condition

Front 28

DNR - Do not resuscitate

Back 28

Individuals who are terminally ill may have given specific do not resuscitate (DNR) instructions

Peace officers are responsible for being aware of and complying with state and local policies and guidelines regarding following such instructions in an emergency situation.

A valid “do not resuscitate” (DNR) or “no-CPR” directive would also be a reason for not beginning CPR on a victim. If there is doubt that the order may not be valid start CPR

Front 29

Duty to continue (providing care)

Back 29

Once a peace officer initiates medical services, that officer must remain with the victim until the officer is relieved by:
- an individual with equal or greater training and skill, or
- the scene becomes unsafe for the officer to remain or the officer is physically unable to continue

Front 30

Victim assessment - 2 part process

Back 30

Primary assessment

Secondary assessment

Front 31

Primary assessment

Back 31

Rapid, systematic process to detect life-threatening conditions

1 - Check for responsiveness
2 - Check (ABC)
- Airway
- Breathing
- Circulation (pulse)
3 - Control major bleeding
4 - Treat for shock
5 - Consider C-spine stabilization based on mechanism of injury

Front 32

Secondary assessment

Back 32

Systematic examination to determine whether injuries exist

1 - Check and document vital signs:
- Skin Color
- Temperature
- Respiratory Rate
- Pulse Rate
2 - Gather initial information regarding the victim and the incident
3 - Conduct a head-to-toe check to identify injuries

Front 33

Respiration

Back 33

The act of breathing is called respiration

Front 34

Responsiveness

Back 34

•Before taking any action, the victim’s level of responsiveness (mental status) should be determined.

•To determine responsiveness, the peace officer should speak with the victim directly, asking, “Are you okay?”

•If the victim does not respond, the officer should tap the victim or shout in order to elicit a response from the victim.

Depending on the level of responsiveness, a victim may be determined to be:
• alert, awake and oriented (i.e., can talk and answer question appropriately)
• responsive to verbal stimuli (e.g., talking or shouting)
• responsive to painful stimuli (e.g., tapping or pinching, earlobe, or skin above collar bone rubbing

Front 35

Primary assessment - responsiveness

Back 35

IF the victim is UNRESPONSIVE
THEN the officer should:
• activate the EMS system
• check the victim’s breathing and circulation

IF the victim is RESPONSIVE
THEN the officer should:
• control any major bleeding
• treat for shock
• activate the EMS system if necessary

Front 36

Primary assessment - breathing

Back 36

The responding peace officer should determine if the victim is breathing.

When a victim is alert and able to speak, it can be assumed that the victim has a clear airway and is able to breath.

• Make a quick visual check for normal breathing.

IF the victim is NOT BREATHING
THEN the officer should:
• check for pulse (no longer than 10 seconds)

IF the victim is BREATHING
THEN the officer should:
• complete primary survey

Front 37

Primary assessment - circulation (pulse)

Back 37

The presence of a pulse is an indication that the victim’s heart is functioning.

1 - Place an index and middle finger on the front of the victim’s throat at the largest cartilage of the larynx (“Adam’s apple”).
2 - Slide fingers off the victim’s throat to the side of the neck toward the rescuer.
3 - Position fingers between the trachea (“windpipe”) and the large muscles on the side of the victim’s neck for five to ten seconds.

IF the victim has NO PULSE
THEN the officer should:
• begin cardiopulmonary resuscitation (CPR)

IF the victim has PULSE BUT NOT BREATHING
THEN the officer should:
• begin rescue breathing

IF the victim has PULSE, BREATHING, BUT UNCONSCIOUS
THEN the officer should:
• check for indications of life-threatening conditions (e.g., major bleeding, shock, etc.)
• place the victim in the recovery position (on the side with the head supported by the lower forearm), if appropriate, to aid breathing and allow fluids or vomit to drain from the mouth

IF the victim has PULSE, BREATHING, CONSCIOUS
THEN the officer should:
• check for indications of life-threatening conditions (e.g., major bleeding, shock, etc.)

Front 38

Brachial artery

Back 38

For infants under one year, circulation should be assessed on the brachial artery (inside upper arm between biceps and triceps).

Front 39

Multiple victim assessment

Back 39

Peace officers should move from one victim to another, making a quick (less than one minute) assessment of each victim’s condition and classifying each victim into a category.

Classification categories should be based on assessment of the victim’s breathing, circulation, and mental status.

• Deceased

• Immediate

• Delayed

• Minor

Front 40

Multiple victim assessment

Classification - deceased

Back 40

No respiration after opening the airway

Front 41

Multiple victim assessment

Classification - immediate

Back 41

Receives treatment first, once all victims are classified

Front 42

Multiple victim assessment

Classification - delayed

Back 42

Receives treatment once all victims classified as IMMEDIATE have been treated

Front 43

Multiple victim assessment

Classification - minor

Back 43

Direct to a safe area away from other victims and possible scene safety hazards

Front 44

Multiple victim assessment

Assessment criteria

Back 44

Front 45

Moving a victim - do not move

Back 45

More harm can be done to a victim by moving them than by the original injury. This is especially true if a spinal cord injury is suspected.

DO NOT MOVE any injured victim unless it is absolutely necessary.

An unconscious, injured victim should be treated as though the victim has a spinal injury and therefore should not be moved unless it is absolutely necessary.

Front 46

Moving a victim - conditions for moving a victim

Back 46

A victim should be moved only when the victim is in a life-threatening situation.

• Imminent danger - When the danger outweighs the risk of further injury from being moved

• Unable to assess -

- When it is not possible to do a primary survey of the victim’s condition, i.e., slumped over steering wheel
- When the victim’s condition or an officer’s ability to provide basic life-saving procedures is not possible due to the victim’s position, i.e., providing CPR

Front 47

Moving a victim - guidelines

Back 47

Plan ahead

• Identify a safe location before attempting to move the victim
• Move only as far as is absolutely necessary

Reassure the victim

• Tell the victim(s) what is going on and why the victim is going to be moved
• Keep the victim as calm as possible

Victim stability

• Keep victim in a straight line during the movement
• Keep victim lying down
• Move the victim rapidly but also as carefully and gently as possible
• Be careful not to bump the victim’s head during movement
NOTE: If an infant is fastened in an infant seat, do not remove the infant. Move infant and the seat together.

Front 48

Moving a victim - shoulder drag

Back 48

One maneuver that may be used is the shoulder drag technique.

To avoid straining their backs when dragging a victim, peace officers should:
• bend their knees
• keep their backs straight
• let their leg muscles do most of the work

1 - Use hands and grasp the victim under the armpits.
2 - Stabilize the victim’s head and neck to reduce the risk of injury.
3 - Carefully lift the victim keeping the head and shoulders as close to the ground as possible.
4 - Drag the victim so that the head, torso, and legs remain in a straight line. DO NOT pull sideways.
5 - Gently place the victim in the new location. Assess the victim’s condition.

Front 49

Cardiac arrest

Back 49

If a victim is unresponsive, not breathing, and has no definite carotid pulse to indicate circulation, then the victim is in a state of cardiac arrest.

Front 50

CPR

Back 50

Cardiopulmonary Resuscitation (CPR) is a method of artificially restoring and maintaining a victim’s breathing and circulation. CPR is a key element of basic life support.

In order to survive, oxygenated blood must circulate through the body and reach the victim’s brain. In order to ensure that this process takes place, a peace officer/first responder must:
• provide external chest compressions to circulate the victim’s blood
• maintain an open airway
• provide rescue breaths

Front 51

Clinical death

Back 51

A victim is clinically dead the moment breathing and circulation stop.

Clinical death may be reversible if basic life support techniques such as CPR are initiated immediately.

If any doubt exists as to whether or not the victim is alive, CPR should be started.

Front 52

Biological death

Back 52

When a victim’s breathing and circulation stop and brain cells die due to lack of oxygen, irreversible changes begin to take place, and vital organs begin to deteriorate.

At this point, a victim is biologically dead.

Biological death usually takes place within four to six minutes after breathing and circulation stop.

Front 53

Adult CPR:

One Person

Back 53

Determine responsiveness
• Tap & shout
• Assess for breathing
• No breathing or abnormal breathing
• Activate the EMS system and get AED if available

Pulse check
• Locate the trachea, using 2 or 3 fingers
• Slide these 2 or 3 fingers into the groove between the trachea and the muscles at the side of the neck, where you can feel the carotid pulse
• Feel for a pulse for at least 5 but no more than 10 seconds. If you do not definitely feel a pulse, begin CPR, starting with chest compressions

Chest compression
• Position yourself at the victim’s side
• Make sure the victim is lying faceup on a firm, flat surface. If the victim is lying facedown, carefully roll him faceup. If you suspect the victim has a head or neck injury, try to keep the head, neck, and torso in a line when rolling the victim to a faceup position

• Put the heel of one hand on the center of the victim’s chest on the lower half of the breastbone
• Put the heel of your other hand on top of the first hand
• Straighten your arms and position you shoulders directly over your hands
• Push hard and fast
− Press down at least 2 inches (5 cm) with each compression (this requires hard work). For each chest compression, make sure you push straight down on the victims breastbone
− Deliver compressions in a smooth fashion at a rate of at least 100/min
− At the end of each compression, make sure you allow the chest to recoil (re-expand) completely. Chest recoil allows blood to flow into the heart and is necessary for chest compressions to create blood flow. Incomplete chest recoil is harmful because it reduces the flood flow created by chest compressions. Chest compression and chest recoil/relaxation times should be approximately equal
− Minimize interruptions

Ventilation
• Open the victim’s airway using head-tilt or jaw-thrust maneuver
• Provide ventilation
• Give 2 breaths with each lasting 1 second
• Victim’s chest to visibly rise

Compression Cycle
• After 30 compressions, open victim’s airway, give two breaths
• Continue cycle of 30 compressions to 2 breaths

NOTE: If unsure there is a pulse, continue CPR.

Front 54

Adult CPR:

Two Person

Back 54

Determine responsiveness
• Tap & shout
• Assess for breathing
• No breathing or abnormal breathing
• Activate the EMS system and get AED if available

Pulse check
• Locate the trachea, using 2 or 3 fingers
• Slide these 2 or 3 fingers into the groove between the trachea and the muscles at the side of the neck, where you can feel the carotid pulse
• Feel for a pulse for at least 5 but no more than 10 seconds. If you do not definitely feel a pulse, begin CPR, starting with chest compressions

Chest compression
• Position yourself at the victim’s side
• Make sure the victim is lying faceup on a firm, flat surface. If the victim is lying facedown, carefully roll him faceup. If you suspect the victim has a head or neck injury, try to keep the head, neck, and torso in a line when rolling the victim to a faceup position
• Put the heel of one hand on the center of the victim’s chest on the lower half of the breastbone
• Put the heel of your other hand on top of the first hand
• Straighten your arms and position you shoulders directly over your hands

• Push hard and fast
− Press down at least 2 inches (5 cm) with each compression (this requires hard work). For each chest compression, make sure you push straight down on the victims breastbone
− Deliver compressions in a smooth fashion at a rate of at least 100/min
− At the end of each compression, make sure you allow the chest to recoil (re-expand) completely. Chest recoil allows blood to flow into the heart and is necessary for chest compressions to create blood flow. Incomplete chest recoil is harmful because it reduces the flood flow created by chest compressions. Chest compression and chest recoil/relaxation times should be approximately equal
− Minimize interruptions

Ventilation
• Open the victim’s airway using head-tilt or jaw-thrust maneuver
• Provide ventilation
• Give 2 breaths with each lasting 1 second
• Victim’s chest to visibly rise

Compression Cycle
• After 30 compressions, open victim’s airway, give two breaths
• Continue cycle of 30 compressions to 2 breaths
• Every 5 cycles or approximately every 2 minutes duties should be switched
• Switching duties with the second rescuer should take less than 5 seconds

NOTE: If unsure there is a pulse, continue CPR.

NOTE: All findings, counting, etc. should be announced clearly and out loud to avoid confusion between the assisting peace officers.

NOTE: When performing two-person CPR, the rescuer providing chest compressions may become fatigued and reduce the effectiveness of CPR.

Front 55

Child CPR:

One Person

Back 55

The technique for performing CPR on a child, (one year to puberty) is similar to that for adults, but with adjustments that take into account the child’s size.

Determine responsiveness
• Establish responsiveness
• Assess for breathing
• No breathing or only gasping
• Shout for help
• If someone responds, send that person to activate the emergency response system and get the AED
NOTE: If alone and child collapsed in front of you, you may leave the child to activate the EMS system and obtain an AED. If unwitnessed perform CPR for 5 cycles (approximately 2 minutes) before activating EMS.

Pulse check
• Check carotid pulse (no longer than 10 seconds)
• Locate the trachea, using 2 or 3 fingers
• Slide these 2 or 3 fingers into the groove between the trachea and the muscles at the side of the neck, where you can feel the carotid pulse
• If no pulse or less than 60 beats per minute (BPM) with poor perfusion, start compressions
• If within 10 seconds you don’t definitely feel a pulse or if, despite adequate oxygenation and ventilation, the heart rate is less than 60/min with signs of poor perfusion, perform cycles of compressions and breaths (30:2) ratio), starting with compressions
• After 5 cycles, if someone has not already done so, activate the EMS and get the AED (or defibrillator). Use the AED as soon as it is available

Chest Compressions

• Position yourself at the child’s side
• Make sure the child is lying faceup on a firm, flat surface. If the child is lying facedown, carefully roll him faceup. If you suspect the child has a head or neck injury, try to keep the head, neck, and torso in a line when rolling the child to a faceup position
• Put the heel of one hand on the center of the child’s chest on the lower half of the breastbone
• Put the heel of your other hand on top of the first hand
• For very small children you may use either 1 or 2 hands for chest compressions
• Straighten your arms and position you shoulders directly over your hands
• Start compressions within 10 seconds of recognition of cardiac arrest
• Push hard, push fast: Compress at a rate of at least 100/min. Chest compression should be at least 1/3 the depth of the chest or approximately 2 inches (5cm)
• Allow complete chest recoil after each compression
• Minimize interruptions in compressions (try to limit interruptions to less than 10 seconds)
• Give effective breaths that make the chest rise
• Avoid excessive ventilation

Ventilation
• Open the victim’s airway using head-tilt or jaw-thrust maneuver
• Provide ventilation
• Give 2 breaths with each lasting 1 second
• Victim’s chest to visibly rise

Compression Cycle
• After 30 compression, open victim’s airway, give two breaths
• Continue cycle of 30 compressions to 2 breaths

NOTE: After 5 cycles, if someone has not already activated the EMS system or obtained an AED leave the victim to do this.

Front 56

Child CPR:

Two Person

Back 56

Determine responsiveness
• Tap & shout
• Assess for breathing
• No breathing or only gasping
• Shout for help
• If someone responds, send that person to activate the emergency response system and get the AED

NOTE: If alone and child collapsed in front of you, you may leave the child to activate the EMS system and obtain an AED. If unwitnessed perform CPR for 5 cycles (approximately 2 minutes) before activating EMS.

Pulse check
• Check carotid pulse (no longer than 10 seconds)
• Locate the trachea, using 2 or 3 fingers
• Slide these 2 or 3 fingers into the groove between the trachea and the muscles at the side of the neck, where you can feel the carotid pulse
• If no pulse or less than 60 beats per minute (BPM) with poor perfusion, start compressions
• If within 10 seconds you don’t definitely feel a pulse or if, despite adequate oxygenation and ventilation, the heart rate is less than 60/min with signs of poor perfusion, begin CPR, starting with chest compressions
• After 5 cycles, if someone has not already done so, activate EMS and get the AED (or defibrillator). Use the AED as soon as it is available

Chest Compressions
• Position yourself at the child’s side
• Make sure the child is lying faceup on a firm, flat surface. If the child is lying facedown, carefully roll him faceup. If you suspect the child has a head or neck injury, try to keep the head, neck, and torso in a line when rolling the child to a faceup position
• Put the heel of one hand on the center of the child’s chest on the lower half of the breastbone
• Put the heel of your other hand on top of the first hand
• For very small children you may use either 1 or 2 hands for chest compressions
• Straighten your arms and position you shoulders directly over your hands
• Start compressions within 10 seconds of recognition of cardiac arrest
• Push hard, push fast: Compress at a rate of at least 100/min. Chest compression should be at least 1/3 the depth of the chest or approximately 2 inches (5cm)
• Allow complete chest recoil after each compression
• Minimize interruptions in compressions (try to limit interruptions to less than 10 seconds)
• Give effective breaths that make the chest rise
• Avoid excessive ventilation

Ventilation
• Open the victim’s airway using head-tilt or jaw-thrust maneuver
• Provide ventilation
• Give 2 breaths with each lasting 1 second
• Victim’s chest to visibly rise

Compression Cycle
• Use a compression-to-breaths ratio of 15:2 for children per American Heart Association 2010 guidelines.

Front 57

Infant CPR:

One Person

Back 57

The technique for performing CPR on a infant, (under one year of age) is similar to that for a child, but with adjustments that take into account the infant’s size.

Determine responsiveness
• Tap & shout
• Assess for breathing
• No breathing or only gasping
• Shout for help
• If someone responds send that person to activate the EMS system and get AED if available

Pulse check
• Check brachial pulse (no longer than 10 seconds)
• Place 2 or 3 fingers on the inside of the upper arm, between the infant’s elbow and shoulder
• Press the index and middle fingers gently on the inside of the upper arm for at least 5 but no more than 10 seconds when attempting to feel the pulse
• If no pulse or less than 60 beats per minute (BPM) with poor perfusion, perform cycles of compressions and breathes (30:2) ratio, starting with compressions
• After 5 cycles, if someone has not already done so, activate EMS and get the AED (or defibrillator)

Chest compression
• Place the infant on a firm, flat surface
• Place 2 fingers in the center of the infant’s chest just below the nipple line. Do not press on the bottom of the breastbone
• Push hard and fast. To give chest compressions, press the infant’s breastbone down at least one third the depth of the chest (approximately 1 ½ inches (4cm)). Deliver compressions in a smooth fashion at a rate of at least 100/min
• At the end of each compression, make sure you allow the chest to recoil (re-expand) completely. Chest recoil allows blood to flow into the heart and is necessary to create blood flow during chest compressions. Chest compression and chest recoil/relaxation times should be approximately equal.
• Minimize interruptions in chest compressions

Ventilation
• Open the victim’s airway using head-tilt or jaw-thrust maneuver
• Provide ventilation
• Give 2 breaths with each lasting 1 second
• Victim’s chest to visibly rise

Compression Cycle
• After 30 compression, open victim’s airway, give two breaths
• Continue cycle of 30 compressions to 2 breaths

NOTE: After 5 cycles, if someone has not already activated the EMS system or obtained an AED leave the victim to do this.

Front 58

Infant CPR:

Two Person

Back 58

Determine responsiveness
• Tap & shout
• Assess for breathing
• No breathing or only gasping
• Send second rescuer to activate the EMS system and get AED (or defibrillator)

Pulse check
• Check brachial pulse (no longer than 10 seconds)
• Place 2 or 3 fingers on the inside of the upper arm, between the infant’s elbow and shoulder
• Press the index and middle fingers gently on the inside of the upper arm for at least 5 but no more than 10 seconds when attempting to feel the pulse
• If no pulse or less than 60 beats per minute (BPM) with poor perfusion, perform cycles of compressions and breathes (15:2) ratio, starting with compressions

Chest compression
• Place both thumbs side by side in the center of the infant’s chest on the lower half of the breastbone. The thumbs may overlap in very small infants
• Encircle the infant’s chest and support the infant’s back with the fingers of both hands
• With your hands encircling the chest, use both thumbs to depress the breastbone approximately one third the depth of the infant’s chest (approximately 1½ inches (4cm))
• Deliver compressions in a smooth fashion at a rate of at least 100/min.
• After each compression, completely release the pressure on the breastbone and allow the chest to recoil completely
• After every 15 compressions, pause briefly for the second rescuer to open the airway with a head tilt-chin left and give 2 breaths. The chest should rise with each breath
• Continue compressions and breaths in a ratio of 15:2 (for 2 rescuers), switching roles every 2 minutes to avoid rescuer fatigue

Ventilation
• Check the victim for a response and for breathing
• If there is no response and no breathing or only gasping, send the second rescuer to activate the emergency response system and get the AED (or defibrillator)
• Check the infant’s brachial pulse (take at least 5 but no more than 10 seconds)
• If there is no pulse or if, despite adequate oxygenation and ventilation, the heart rate (pulse) is <60/min with signs of poor perfusion, perform cycles of compressions and breaths (30:2 ratio), starting with compressions. When the second rescuer arrives and can perform CPR, use compression-ventilation ratio of 15:2
• Use the AED (or defibrillator) as soon as it is available

Compression Cycle
• Use a compression-to-breaths ratio of 15:2 for infants per American Heart Association 2010 guidelines.

Front 59

Pausing CPR

Back 59

Minimize interruptions in compressions to 10 seconds or less.

It should be paused for as short a time as possible not longer than 10 seconds.

Front 60

Stopping CPR

Back 60

CPR must be continued until:
• the victim’s breathing resumes
• the officer is relieved by an equally or higher medically trained person
• the officer is too exhausted to continue
• environmental hazards endanger the rescuer (e.g., gun shots)

Front 61

AED

Back 61

Automated External Defibrillators (AED)

The best treatment for most cases of sudden cardiac arrest is immediate treatment with a defibrillator, a device that shocks the heart out of fatal rhythm, allowing normal, healthy rhythm to resume.

Front 62

AED Protocol

Back 62

The AED protocol has seven basic steps:
• Check for responsiveness and breathing
• Activate the EMS system if unresponsive
• Get the AED if readily available
• Check for pulse. A second rescuer should continue CPR until the AED is attached
• Attach the AED electrode pads
• Allow the AED to analyze the heart rhythm. Make sure no one is touching the victim
• If a shock is indicated verbalize “all clear” prior to pressing the “shock” button. Follow the voice prompts from the AED
• Current AHA guidelines recommend that an AED should be used as soon as available.

Front 63

AED Cautions

Back 63

AEDs are designed to be used for adults, children and infants.
• AEDs are safe in all weather conditions (on dry skin)
• Never place AED electrode pads directly on top of medication patches. Remove patches first and wipe the skin dry
• If the victim has a pacemaker or an internal defibrillator with a battery pack (visible as a lump under the skin, approximately two inches long) avoid placing pads directly on top of the implant
• If the victim is lying on a metal surface (e.g. bleachers) avoid contact of the electrodes with the metal surface

NOTE: Remove any jewelry from the patient’s chest.

NOTE: Persons with excessive chest hair may need to be shaved prior to application of the AED electrodes.

Front 64

Respiratory failure

Back 64

Respiratory failure is the inability to intake oxygen, to the point where life cannot be sustained.

Front 65

Respiratory arrest

Back 65

When breathing stops completely, the victim is in respiratory arrest

Front 66

Cardiac arrest

Back 66

A state when a victim is unresponsive, not breathing, and has no carotid pulse to indicate circulation

Front 67

Airway obstructions - consideration for spinal cord injury

Back 67

Prior to any attempt to open a victim’s airway, peace officers must consider whether or not the victim may have suffered any type of spinal injury.

If head, neck, or spinal cord injury is suspected, the victim’s head and neck may need to be protected by providing as much manual stabilization as possible.
Indications of head, neck, or spinal injury may include, but not be limited to:
• the mechanism of injury (e.g., falling from a high position, vehicle collision, etc.)
• information provided by bystanders/witnesses

NOTE: Whenever a victim is found unconscious, responding officers should suspect a spinal cord injury and act accordingly

Front 68

Opening an airway - two methods

Back 68

head-tilt/chin-lift

jaw-thrust

Front 69

Head-Tilt/ Chin-Lift

Back 69

Provides maximum airway opening

1
• Place one hand on the victim’s forehead
• Place the fingers of the other hand under the bony area at the center of the victim’s lower jaw

2
• Tilt the victim’s head back by:
- pressing backward on the forehead
- lifting the chin with the fingers

3

• Move the jaw forward to a point where the lower teeth are almost touching the upper teeth
• If necessary, use the thumb of the hand supporting the chin to pull open the victim’s mouth

NOTE: Should not use the head-tilt/chin-lift maneuver if there are any indications of possible head, neck, or spinal cord injury.

NOTE: Do not compress the soft tissues under the lower jaw. This may obstruct the victim’s airway.

NOTE: Do not place thumb or finger(s) inside the victim’s mouth.

Front 70

Jaw-Thrust

Back 70

Use:

• When head, neck, or spinal injury is suspected
• To open airway on an unconscious victim
• Allows airway to be opened without moving the victim’s head or neck

1
• Take a position at the top of the victim’s head

2
• Gently place one hand on each side of the victim’s head
• Place your fingers under the angles of the victim’s lower jaw and lift with both hands, displacing the jaw forward
• Place thumbs on the victim’s cheeks
• Stabilize the victim’s head

3
• Using the fingers, gently push the victim’s jaw forward
• If necessary, use thumb to pull open the victim’s lips

Front 71

Special considerations when attempting to open a victim’s airway

Back 71

Infants and Children
• Trachea (“windpipe”) is narrower, softer, and more flexible than in adults
• Over extension of an infant’s/child’s neck may occlude the trachea
• Tongue takes up more space in the mouth than adults
• Airways are smaller and easily obstructed

Facial Injuries
• Severe swelling and bleeding may block airway

Dental Appliances
• Normally, full/partial dentures should be left in
• Remove only if they have become dislodged during the emergency and endanger the victim’s airway

Front 72

Airway obstructions

Back 72

An airway obstruction can be either mild or severe. They are caused by a number of different materials blocking the person’s air passages.

Mild airway obstructionExamples include, but are not limited to the following.
• Victim’s tongue
• Vomit or blood
• Broken teeth or dentures
• Foreign objects such as toys, ice, food

Front 73

Mild airway obstruction

Back 73

If the victim indicates an airway problem (i.e., choking) but is able to speak or cough, the victim is experiencing a mild airway obstruction. With a mild airway obstruction, it may be assumed that there is adequate air exchange to prevent respiratory failure.

A victim who is conscious with a mild airway obstruction should be encouraged to cough forcefully to dislodge and expel the object.

Do not interfere with the victim’s attempts to cough (e.g., pound on the victim’s back). This could lodge the obstruction even further, causing a severe airway obstruction. If the obstruction cannot be removed by coughing and the victim has labored breathing, is making unusual breathing sounds, or is turning blue/grey, the victim should be treated as if there is a severe airway obstruction.

NOTE: Grabbing the throat with one or both hands, indicating the victim is unable to breathe, is considered the universal sign of choking.

Front 74

Severe airway obstruction

Back 74

The victim may be experiencing a severe airway obstruction if:
• unconscious and unable to be ventilated after the airway has been opened
• conscious but unable to speak, cough, or breathe

Under such conditions, additional measures may be required to free the victim’s airway from a severe obstruction. The two primary maneuvers used are the abdominal thrust (if conscious) and chest compressions/attempt to ventilate (if unconscious).

Front 75

Tongue obstruction

Back 75

A large number of severe airway obstructions leading to respiratory failure are caused by the victim’s own tongue.

In the unconscious victim, the muscles of the lower jaw relax and the tongue can lose muscle tone. When this happens, the tongue may block the victim’s airway.

Front 76

Removing airway obstruction - finger sweep

Back 76

If any object causing the obstruction can be seen it might be removed by using a finger sweep.

To conduct a finger sweep:
• open the victim’s mouth by grasping both the tongue and lower jaw between the thumb and fingers
• insert the index finger of the other hand down along the cheek and then gently into the throat in a “hooking” motion
• if the object can be felt, grasp it and remove it

NOTE: The finger sweep maneuver should be done with care so that the object is not forced further into the victim’s throat.

NOTE: Do not use a blind finger sweep. Objects should be removed from their mouths only if the objects can be seen clearly.

Front 77

Abdominal thrust

Back 77

The abdominal thrust (also referred to as the Heimlich maneuver) is one method used to force obstructions from a victim’s airway that cannot be removed with a finger sweep. Abdominal thrusts force air out of the lungs, expelling the obstruction, and clearing the victim’s airway.

Conscious Choking Adult or Child
1
• Ask the victim, “Are you choking?”, “Can I help you?”
• Determine that the victim is choking (i.e., unable to speak, cough, or breathe)
• Inform the victim before taking action
2
• Stand or kneel behind the victim and wrap your arms around the victim’s waist
3
• Make a fist with one hand
4
• Place the thumb side of the fist against the victim’s abdomen, in the midline slightly above the navel and well below the breastbone
5
• Grasp your fist with your other hand and press your fist into the victim’s abdomen with a quick, forceful upward thrust
6
• Give each new thrust with a separate, distinct movement to relieve the obstruction

Unconscious Adult or Child
1
• Activate the EMS system
• Place victim in a supine position
NOTE: When the victim is a child, officers should have a second person (if available) activate the EMS system, while the peace officers/first responders begin the maneuver immediately.
2
• Open the victim’s airway
• Look inside the victim’s mouth
• Conduct a finger sweep of the victim’s mouth, only if you see the object (Do not use a blind finger sweep.)
• Attempt to ventilate victim’s lungs
• If airway remains obstructed, reposition the victim’s head and attempt to ventilate again
• If airway remains obstructed, perform 30 chest compressions, look in the airway, remove any visible debris, attempt to ventilate
• Repeat this procedure until chest rise is achieved during an attempted ventilation

NOTE: Abdominal thrusts should not be used on infants, pregnant women or obese patients. Instead use chest thrusts.

NOTE: Prior to each ventilation, look in mouth for obstruction.

Front 78

Chest thrusts

Back 78

The chest thrust is another maneuver that can be used to force obstructions from a victim’s airway. Chest thrusts are used in place of abdominal thrusts when the victim is:
• pregnant
• obese

Conscious Choking Adult
1
• Ask the victim, “Are you choking?” “Can I help you?”
• Determine that the victim is choking (i.e., unable to speak, cough, or breathe)
• Inform the victim before taking action
2
• Take a position behind the victim who is standing or sitting
• Slide arms under the victim’s armpits and encircle the victim’s chest
3
• Form a fist with one hand
• Place the thumb side of fist on the midline of the victim’s sternum, level with the armpits
• Grasp the fist with the free hand
4
• Direct thrusts straight back toward the victim’s spine
• Use care not to direct thrusts up, down, or to either side
5
• Repeat thrusts until object is expelled or victim loses consciousness

Front 79

Choking Infants

Back 79

A combination of back blows and chest compressions may be used to clear a foreign body from an infant’s airway.

Conscious Choking Infant
1
• Kneel or sit with the infant in your lap
2
• If it is easy to do, remove clothing from the infant’s chest
3
• Deliver up to 5 back slaps forcefully between the infant’s shoulder blades, using the heel of your hand. Deliver each slap with sufficient force to attempt to dislodge the foreign body
4
• After delivering up to 5 back slaps, place your free hand on the infant’s back, supporting the back of the infant’s head with the palm of your hand. The infant will be adequately cradled between your 2 forearms, with the palm of one hand supporting the face and jaw while the palm of the other hand supports the back of the infant’s head
5
• Turn the infant as a unit while carefully supporting the head and neck. Hold the infant faceup, with your forearm resting on your thigh. Keep the infant’s head lower than the trunk
6
• Provide up to 5 quick downward chest thrusts in the middle of the chest over the lower half of the breastbone (same as for chest compressions during CPR). Deliver chest thrusts at a rate of about 1 per second, each with the intention of creating enough force to dislodge the foreign body
7
• Repeat the sequence of up to 5 back slaps and up to 5 chest thrusts until the object is removed or the infant becomes unresponsive

Conscious Infant becomes Unconscious
1
• Activate the EMS system
• If someone responds, send that person to activate the emergency response system.
• Place the infant on a firm, flat surface
2
• Begin CPR (starting with compressions) with 1 extra step: each time you open the airway, look for the obstructing object in the back of the throat. If you see an object and can easily remove it, remove it
3
• After approximately 2 minutes of CPR (C-A-B sequence), activate the emergency response system (if no one has done so)

NOTE: Do not perform blind finger sweeps in infants and children because sweeps may push the foreign body back into the airway, causing further obstruction or injury.
If the infant victim becomes unresponsive, stop giving back slaps and begin CPR.

NOTE: Repeat steps 3 through 5 until obstruction is cleared.

Front 80

Rescue breathing

Back 80

Rescue breathing is the process of using one’s own breaths to artificially breathe for a victim.

The rescue breathing process continues until the victim is able to breathe without assistance or other breathing support is provided by EMS personnel.

Front 81

Rescue breathing rates and duration

Back 81

• Give each breath in 1 second
• Each breath should result in visible chest rise
• Check the pulse about every 2 minutes

Adult (Puberty and above) -

Give 1 breath every 5-6 seconds (about 10 to 12 breaths per minute).

Children (newborn to puberty) -

Give 1 breath every 3-5 seconds (about 12 to 20 breaths per minute).

Front 82

Rescue breathing technique

Back 82

1
• Open the victim’s airway using the head-tilt-/chin-tilt or jaw-thrust maneuver (whichever is most appropriate for the situation)

2
• Take a position at the top of the victim’s head
• Place portable pocket mask on the victim so the top of the mask is over the victim’s nose while the base of the mask is between the lower lip and chin

3
• Take a breath and exhale directly into the victim’s mouth or through the one-way valve of the mask (one second)
• Use only enough air to create a visible chest rise
• Do not over inflate the lungs
4
• If breaths do not enter the victim’s lungs:
- reposition the victim’s head to open the airway
- attempt to breathe into the victim’s lungs again
5
• Continue rescue breathing until:
- victim begins to breathe without assistance
- officer is relieved by an equally or higher medically trained person
- officer becomes too exhausted to continue
- unable to detect a pulse after 2 minutes of rescue breathing, (begin CPR)
- victim is declared dead by an authority

NOTE: If the victim begins to breathe without assistance, continue to assess the victim’s condition. Place in the recovery position, and provide care for shock

Front 83

Rescue breathing - conditions to be aware of

Back 83

If the victim’s mouth is injured and cannot be used for rescue breathing, the peace officer should use a mask-to-nose position.

If the victim has a laryngectomy, a surgical procedure that implants an artificial airway (stoma) in the neck, the peace officer should use a mask-to-stoma position.

For both positions, the same methods should be used as with mouth-to-mouth/face mask techniques for rescue breathing.

Front 84

Rescue breathing - breathing/ pulse checks

Back 84

The victim’s pulse and breathing should be checked approximately every two minutes.

If the victim is:
• not breathing but has a pulse, continue rescue breathing
• not breathing and has no pulse, begin Cardiopulmonary Resuscitation (CPR)

Front 85

Recovery position

Back 85

If the victim resumes adequate breathing and there are no indications of major bleeding or spinal injury, then the victim can be placed in the recovery position.

This position allows for drainage from the mouth and prevents the victim’s tongue from blocking the airway.

To place a victim in the recovery position:
• roll the victim onto their left side toward the rescuer
• keep the victim’s body in one unit with the spine as straight as possible
• move the victim’s lower arm up and bend at the elbow
• move the victim’s top leg toward the victim’s chest, continue monitoring the victim’s breathing

Front 86

Gastric distention

Back 86

Rescue breathing can force some air into the victim’s stomach as well as lungs, causing the stomach to become distended. This condition is referred to as gastric distention.

NOTE: If gastric distention is observed, reposition the airway and give smaller, slower breaths

Front 87

Rescue breathing - Vomiting

Back 87

If a victim vomits, the vomit may enter the lungs and cause further life-threatening complications.

If vomiting should occur:
• Quickly turn the victim onto their side (not just the head) as one unit to keep the spine straight.
• wipe the vomit from the victim’s mouth
• return the victim to the supine position
• open the airway
• continue rescue breathing

This process should take less than 10 seconds to complete.

Front 88

Circulatory system - 3 components

Back 88

The three components to the human circulatory system are the:
• heart
• blood vessels
• blood

If any one component does not function properly, oxygen and nutrients will not reach the body’s major organs in sufficient enough supply to support life.

Front 89

Bleeding control techniques - direct pressure

Back 89

• Direct pressure applied to the bleeding site until bleeding is controlled

• Most common and effective technique
• Should be used first before other bleeding control options
• May be done by firmly applying direct pressure over the bleeding site using a clean dressing and/or a pressure bandage

NOTE: If clean dressing is not available, a gloved hand or other clean material may be used

Front 90

Bleeding control techniques - tourniquet

Back 90

Use of a device to close off all blood flow to and from a limb
• Should only be used for life-threatening conditions when direct pressure has failed

• Can be made of any material wide enough (at least 2 inches) so as to not cut into the victim’s skin (e.g., flat belt, stocking, necktie, etc.)
• Apply close to the wound, between the wound and the victim’s heart (but not over a joint)
• Wrap material around limb and draw tightly to the point where the bleeding is stopped and no further bleeding occurs
• Note the time the tourniquet is placed; report to EMTs
• If victim is covered, leave the area where the tourniquet is located exposed for EMTs to see

NOTE: An improperly applied tourniquet may be removed and reapplied.

Front 91

Dressing

Back 91

A dressing is any material applied to a wound to control bleeding and prevent contamination

Front 92

Bandage

Back 92

A bandage is any material used to hold a dressing in place.

Front 93

Bleeding control techniques - methods

Back 93

Direct pressure and/or tourniquet should be used as the primary bleeding control technique;

however, peace officer/first responder’s may use elevation or pressure points.

Front 94

Open wounds

Back 94

An open wound is any injury where the skin has been broken, exposing the tissue underneath.

Front 95

Abrasion

Back 95

• A scraping away of only outer portion of the skin

For instance
• Rug burns
• Road burns
• Skinned elbows/ knees

Front 96

Incision

Back 96

• Smooth, straight cut
• Caused by sharp objects

For instance
• Paper cuts
• Razors
• Edged weapons

Front 97

Laceration

Back 97

• Jagged-edged wound
• Caused by objects tearing or ripping the skin

For instance
• Broken glass
• Jagged metal
• Saws
• Severe blow or impact with blunt object

Front 98

Puncture
(penetrating)

Back 98

• Deep wound through the skin and other tissue

For instance
• Arrows
• Knives
• Nails
• Bullets
• Impaled objects

Front 99

Avulsion

Back 99

• A part or structure of the body that has been forcibly torn or cut away

For instance
• Tip of nose that is cut off
• External portion of ear torn away
• Eye pulled from its socket

Front 100

Amputation

Back 100

• Surgical or traumatic removal of a body extremity
• Jagged skin and bone edges may be exposed
• May involve massive bleeding

For instance
• Accidents involving chain saws, industrial equipment, etc.

Front 101

Care for open wounds

Back 101

Care of open wounds will require an initial assessment and then action to stop bleeding and prevention of shock.

Assessment
• Expose the injury site before applying bleeding control (e.g., remove, loosen, or cut away clothing covering the wound)
• Assess for possible fractures associated with open wound

Control Bleeding
• Apply direct pressure to stop bleeding
• Apply a pressure bandage
• Apply a tourniquet
• Apply bandages snugly but not so tight as to impair circulation to portions of the body distal (farther away)

Impaled Objects
• Do not attempt to remove the object (Any movement of the object could cause further damage or increased bleeding.)
• Control bleeding by applying pressure on both sides of the object
• Do not put pressure on the object itself
• Stabilize object in place by use of absorbent material

NOTE: If initial bandaging does not stop the blood flow, add additional bandaging. (Do not remove initial bandaging)

Avulsions/ Amputations
• Place partially separated skin or tissue back in proper position before applying dressing and bandage
• Attempt to locate any avulsed part or amputated extremity
• Keep separated part/extremity dry, cool, and protected
• Do not immerse, pack in ice, or freeze separated part/extremity
• Transport separated part/extremity with victim for possible surgical replacement

Circulation
• Monitor pulse below the injury site
• Check capillary circulation by pinching fingertips or toes (Color should return within two seconds to pinched area.)
• If circulation is impaired, loosen bandage (do not remove) until circulation improves

Continued care
• If necessary, immobilize the injury site (e.g., open fracture)
• Keep the victim lying still
• Maintain pressure on wound
• Monitor the victim
• Reassure the victim (Fear and anxiety can increase a victim’s heart rate and circulation.)
• Treat for shock

Front 102

Shock

Back 102

Shock is a life-threatening condition. If not immediately cared for, the victim can die.

Perfusion is the continued flow of blood through the capillaries supplying the body’s tissues and organs with oxygen and removing waste products.

Inadequate perfusion leads to shock.

There may be no relationship between severity of an injury and the onset of shock.

Victims may appear to have no major injury but still show signs of restlessness or anxiety, which are early stages of shock.

For this reason, all victims of traumatic or medical emergencies should be treated for shock upon initial contact.

NOTE: Injuries that might appear be minor or the absence of obvious internal injury can cause a person to go into irreversible shock causing death.

Front 103

Shock - Indications

Back 103

Front 104

Fainting

Back 104

Fainting is a form of shock characterized by sudden unconsciousness. It is caused by dilation of blood vessels resulting in reduced flow of oxygenated blood to the brain.

Front 105

Shock - Treatment

Back 105

All victims should be treated for shock even if no indications of shock are evident. When providing care to treat shock, peace officers/first responders should:
• control all external bleeding and treat other injuries
• be alert for vomiting
• maintain the victim’s body temperature
• place the victim in a position to help maintain blood flow
• reassure the victim
• continue to monitor the victim and be prepared to take action if necessary (e.g., rescue breathing, CPR)

Even though the victim may be thirsty, do not give anything to drink. Shock can cause the gastrointestinal system to shut down. Fluids given orally may lead to vomiting

Front 106

Shock - Positioning victim

Back 106

Front 107

CPR - Review

Back 107

Front 108

Head injury - Indications

Back 108

Head injuries can involve injuries to the skull, scalp, brain, blood vessels and fluid around the brain, and/or neck. They may vary from those involving minor bleeding to those leading to life-threatening conditions and spinal cord injury.

Indications of Possible Head Injury

Mechanism of Injury
• Striking a vehicle’s windshield or dashboard
• Blow to the head
• Falls

Mental Status
• Agitated or confused
• Combative or appears intoxicated
• Decreased level of consciousness (e.g., appears “groggy”)
• Loss of short term memory
• Loss of consciousness (even for a short period of time)

Vital Signs
• Abnormal breathing patterns (e.g., snoring respirations)
• Decreased pulse
• General deterioration of vital signs

Visible Injury
• Deformity of head/skull (e.g., protrusions, depressions, swelling, bruising, etc.)
• Visible bone fragments

Appearance
• Clear or bloody fluid from ears and/or nose
• Unequal pupils
• Bruises behind ears (i.e., “Battle’s sign”)
• Discoloration around eyes (i.e., “raccoon eyes”)
• Paralysis
• Priapism (i.e., penile erection)

Other
• Blurred vision
• Projectile vomiting

Front 109

Head injury - First aid

Back 109

Whenever a victim has suffered a traumatic head or neck injury, brain and spinal cord damage should always be assumed.

Position
• Do not move the victim’s head or neck
• Have the victim remain in the position in which found

Assessment
• Determine level of consciousness
• Conduct a primary and secondary survey
• If unable to establish an open airway using the jaw -thrust technique, the head-tilt chin-lift method may be used

Treatment
• Activate the EMS system
• Control bleeding if necessary
• Be alert for the presence of cerebrospinal fluid in ears or nose. If present, bandage loosely so as not to restrict the flow
• Do not apply direct pressure to any head/skull deformity
• Be prepared for sudden and forceful projectile vomiting
• Treat for shock
• Do not elevate the victim’s legs
• Reassure the victim
• Continue to monitor victim

Front 110

Head injury - Impaled objects

Back 110

Unlike treatment for other situations involving impaled objects, any object (e.g., knives, arrows, screw drivers, etc.) that is impaled into a victim’s cheek or face and causes an airway obstruction should be removed.

If there is no airway obstruction, do not attempt to remove the object.

If the impaled object is obstructing the victim’s airway:
• carefully pull the object out from the direction it entered
• place dressings on both the inside and outside of the cheek to control bleeding

If the object resists coming out, stop. Do not pull any farther. Place a protective device around it to stabilize the object (e.g., paper cup) and secure the device with a bandage.

Front 111

Nosebleeds

Back 111

Victims with facial injuries may experience an accompanying nosebleed.

If this occurs and no spinal injury is suspected, have the victim:
• assume a seated position
• lean slightly forward
• pinch the nose midway at the point where bone and cartilage meet
• maintain the position until bleeding stops

If the victim is unconscious:
• place the victim in the recovery position, if appropriate
• maintain an open airway

NOTE: Do not pack the victim’s nostrils. This could cause blood to back up and create an obstructed airway.

Front 112

Chest and Abdominal Injuries - Blunt trauma

Back 112

Blow to the chest and/or abdomen causing:
• fractured bones and cartilage
• bleeding
• damage to the lungs, heart, great blood vessels (aorta, vena cava), or other vital organs

Front 113

Chest and Abdominal Injuries - Penetrating Object

Back 113

Caused by bullets, knives, metal or glass, etc., can lead to:
• blood loss
• impaired breathing or vital organ damage

Front 114

Chest and Abdominal Injuries - Compression

Back 114

Blunt trauma along with rapid chest and/or abdomen compression (e.g., striking a steering wheel) can lead to:
• blood loss
• heart and vital organ damage
• fractured bones and cartilage
• ruptured lungs, spleen, or other organs

Front 115

Flail chest

Back 115

Flail chest is the condition where the ribs and/or sternum are fractured in such a way that a segment of the chest wall does not move with the rest of chest wall during respiration. It is caused when two or more ribs next to each other are broken.

Front 116

Closed chest wound - indicators

Back 116

Paradoxical breathing

Painful and shallow breathing

Front 117

Paradoxical breathing

Back 117

When both sides of the chest do not move in a synchronized manner

Front 118

Closed chest wound - first aid

Back 118

• Activate EMS system

• Place victim in a
- recovery position, if appropriate, on the injured side with support for the victim’s back
- supine position with a soft object (e.g., coat held firmly over the injured area)

• Both methods will:
- apply pressure to the injured area
- reduce pain
- help the victim breathe easier
- keep the broken section of the chest in line with the rest of the chest

• Treat for shock

• Continue to monitor the victim

Front 119

Open chest wound

Back 119

All open wounds to the chest should be considered life-threatening.

For respiration to take place properly, the chest must function as a vacuum.

With an open chest wound, air may enter the chest area causing a lung to collapse (e.g., sucking chest wound with a punctured lung). Under such conditions, the victim’s ability to breathe, and the victim’s heart function can be greatly impaired.

To prevent air from entering the chest cavity, an occlusive dressing should be applied to the wound as quickly as possible.

Front 120

Occlusive dressing

Back 120

To prevent air from entering the chest cavity, an occlusive dressing should be applied to the wound as quickly as possible.

An occlusive dressing:
• is a nonporous dressing (e.g., plastic bag)
• used to cover the wound
• creates an air-tight seal

NOTE: As the victim inhales, the dressing is sucked tight to the skin, providing a seal over the wound. If the dressing is placed properly, respiration should partially stabilize.

Front 121

Applying an occlusive dressing

Back 121

1
Place a gloved hand over the wound to “seal” the wound
2
Without moving the hand covering the wound, use the free hand to place a piece of plastic over the hand covering the wound site
NOTE: The plastic should be at least two inches wider than the wound itself.
3
While using the free hand to apply gentle pressure and maintain the seal around the wound, gently remove the other hand from under the plastic
4
Tape all but one corner of the plastic in place. The untaped corner will allow air to escape from the chest cavity when the victim coughs
5
Provide care to prevent shock. Continue to monitor the victim

NOTE: If the chest has both entrance and exit wounds, occlusive (airtight) dressings should be placed on both wounds. The physically higher wound should be vented.

Front 122

Closed abdominal wound - indicators

Back 122

• Victim found lying in a fetal position (with legs pulled up to chest)
• Rapid shallow breathing
• Rapid pulse
• Rigid or tender abdomen with or without swelling
• Pain or tenderness to the touch during secondary survey

Front 123

Closed abdominal wound - first aid

Back 123

• Activate EMS system
• If no spinal injury suspected, place victim in a comfortable position (e.g., supine with knees bent up)
• Treat for shock
• Continue to monitor the victim
• Be prepared for the victim to vomit

Front 124

Open abdominal wounds - first aid

Back 124

An open abdominal wound can be caused by lacerations and punctures to the abdomen. Blood loss and the potential for infection should be of concern when dealing with an open wound to the abdomen.

Assessment
• Determine the victim’s state of consciousness
• Conduct primary and secondary surveys

Treatment
• Activate EMS system
• If no spinal injury is suspected, place the victim in a supine position with the knees up
• Apply sterile dressing over the wound to control bleeding
• Treat for shock
• Continue to monitor the victim

Front 125

Open abdominal wounds - Protruding organs

Back 125

If any organs or portion of an organ protrude from the abdominal wound, do not attempt to touch, move, or replace them. Cover the organ and the rest of the wound with a moist dressing and seal with an occlusive dressing

Front 126

Open abdominal wounds - Protruding organs - first aid

Back 126

Assessment
• Determine the victim’s state of consciousness
• Conduct primary and secondary surveys

Treatment
• Activate EMS system
• If no spinal injury is suspected, place the victim in a supine position with the knees up
• Cover with moist sterile dressing, if available
• Seal with airtight bandage
• Treat for shock
• Continue to monitor the victim
NOTE: If sterile materials are not available the airtight bandage should be applied over the injury

Front 127

Musculo-skeletal system

Back 127

The musculoskeletal system is the system of bones, muscles, and other tissue that support and protect the body and permit movement.

The components of the musculoskeletal system include bones, joints, skeletal muscles, cartilage, tendons, and ligaments.

Front 128

Bone

Back 128

• Hard yet flexible tissue
• Provides support for the body as well as protection of the vital organs

Front 129

Joint

Back 129

• Place where bones fit together
• Proper function critical in order for the body to move

Front 130

Skeletal Muscle

Back 130

• Soft fibrous tissue
• Controls all conscious or deliberate movement of bones and joints

Front 131

Cartilage

Back 131

• Connective tissue that covers the outside of the ends of bones
• Firm but less rigid than bone
• Helps form certain flexible structures of the body (e.g., external ear, connections between the ribs and sternum, etc.)
• Allows for smooth movement of bones at joints

Front 132

Tendon

Back 132

Bands of connective tissue that bind muscles to bones

Front 133

Ligament

Back 133

• Connective tissue that attaches to the ends of bones and supports joints
• Allows for a stable range of motion

Front 134

Musculo-skeletal injuries - 3 types of force

Back 134

Direct
• Direct blow to an area
• Example: Being struck by an automobile

Indirect
• Force from a direct blow to one area which causes damage to another
• Example: Landing on feet from a fall and injuring ankles, knees, etc.

Twisting
• Sudden rapid movement that stretches or tears
• Example: Football and other sport related injuries

Front 135

Musculo-skeletal injuries - common 4 injuries

Back 135

The four most common injuries are fractures, dislocations, sprains, and strains

Front 136

Fractures

Back 136

• Complete or partial break of a bone
• Includes:
- open fractures where there is a break in the skin at the site of the fracture
- closed fractures where there is no break in the skin at the site of the fracture

Indicators:

• Limb deformity (differences in size or shape)
• Swelling or discoloration to the area
• Tenderness and localized pain
• Breaking and/or grating sound
• Possible loss of function

Front 137

Dislocations

Back 137

• When a bone is pushed or pulled out of alignment from a joint

Indicators:

• Constant pain
• Increased pain with movement
• Joint deformity
• Swelling
• Loss of movement (i.e., “frozen joint”)

Front 138

Sprains

Back 138

• Severely stretched or torn ligaments
• Associated with joint injuries

Indicators:

• Pain
• Swelling
• Discoloration

Front 139

Strains

Back 139

• Over-stretching or tearing of muscle

Indicators:

• Pain
• Swelling
• Discoloration

Front 140

Musculo-skeletal injuries - first aid

Back 140

Assessment
• Conduct a primary and secondary assessment to determine if there are any life-threatening injuries

Treatment
• Activate EMS system, if necessary
• Do not attempt to manipulate or “straighten out” an injury
• Expose the injury by removing clothing covering the area
• Control bleeding associated with open fractures
• Stabilize the injury by immobilizing the bones above and below the joint
• Check capillary refill and warmth of affected limb
• Treat for shock
• Do not elevate legs if injury is to the lower extremities

Front 141

Burn

Back 141

A burn is an injury caused by heat, chemicals, or electricity. Burns can involve just the outer-most layer of the skin or go deeper into structures below the skin including muscle, bone, nerves, and blood vessels. Along with physical damage, victims with burns can also experience great pain and emotional trauma from the injury.

Front 142

Burn - victim assessment

Back 142

Prior to any first aid measures, no matter how extreme the burn, a victim assessment including primary and secondary surveys should be conducted.

Only when immediate life-threatening conditions have been addressed, should the peace officer’s attention be directed to first aid treatment for the burns themselves. Burns to the face, nose and mouth may be life threatening due to respiratory distress.

Front 143

Burn - Classification

Back 143

Burns involving the skin are classified according to the depth of the burn in the tissue. Classifications include first-degree burns, second-degree burns, and third-degree burns

Front 144

Burn - first-degree

Back 144

Depth of Injury
• Damage only to the epidermis (outer-most layer of the skin)
• Also referred to as superficial burns

Additional Information

• Skin appears red
• Can be very painful
• Damage usually heals without scarring
• Example: mild sunburn

Front 145

Burn - second-degree

Back 145

Depth of Injury
• Damage to the epidermis and the dermis (second layer of the skin containing nerves, hair follicles, and sweat glands)
• Also referred to as partial thickness burns

Additional Information

• Skin appears red and mottled (spotted)
• Accompanied by blisters (plasma and fluid released from tissue that rises to top layer of skin)
• May involve swelling
• Causes intense pain
• May produce slight scarring

Front 146

Burn - third-degree

Back 146

Depth of Injury

• Damage to the epidermis, dermis, and into fatty layer and muscle beneath the skin
• Also referred to as full thickness burns

Additional Information

• Most serious of all burns
• Skin appears dry, leathery, and discolored (white, brown, or black)
• May be extremely painful or the victim may experience little pain if nerve endings have been destroyed
• May require skin grafting to heal
• Causes dense scar formation

Front 147

Burn - common types

Back 147

The most common types of burns are thermal burns, chemical burns, and electrical burns.

Front 148

Burn - first aid - thermal

Back 148

Thermal Burns
• Caused by direct heat
• Possible causal agents include:
- Radiation (exposure to sun, radioactive material)
- Fire
- Steam
- Hot liquids
- Hot objects

• Activate EMS system
• Remove victim from source of heat
• Stop the burning process by cooling burned area with cool water
• Apply a dry sterile dressing and bandage loosely
• Treat for shock
• Monitor victim

NOTE: Over cooling 3rd degree burns may lead to hypothermia.

Front 149

Burn - first aid - chemical

Back 149

Chemical Burns
• Caused by acids or alkalis coming into contact with the skin
• Most frequently occurs in industrial settings

• Activate EMS system
• Peace officers should wear protective gloves and eyewear during the flushing process
• If chemical is a dry powder, brush away as much chemical as possible before flushing with water
• Remove excess chemical, exposed clothing, or jewelry prior to the flushing process to prevent injury to other parts of the body
• Flush affected area with water for 15-30 minutes
• After flushing, cover burned area with dry sterile dressing
• Treat for shock
• Monitor victim

NOTE: Bandage should hold dressing in place and protect the area from contaminants. Bandaging too tightly may not only cause pain but also restrict swelling.

Front 150

Burn - first aid - electrical

Back 150

Electrical Burns
• Occur when the body becomes a conduit for electrical current
• Sources include:
- alternating current
- direct current
- lightning
• May cause extensive internal injuries to the:
- heart (cardiac arrest)
- central nervous system
- vital organs

• Ensure that the scene is safe to enter
• DO NOT touch the victim’s body until the source of the current has been turned off
• If necessary, begin CPR immediately
• Examine the victim for external wounds including burns caused by
- contact to thermal heat (metal),
- the source of current coming into contact with the body (entrance wound), and
- current leaving the body (exit wound).
• Treat all wounds the same as with thermal burns
• Treat for shock
• Monitor victim

NOTE: Entrance and exit wounds caused by electrical current may be difficult to see initially. They will be found in different locations on the victim’s body. For example, if the victim touches a live wire, current may enter the body through the hand, pass through the body, and exit through the victim’s feet.

Front 151

Burn - first aid - radiation

Back 151

Radiation Burns
• Radiation sickness that occurs when the body is exposed to radiation in either a single large dose or chronically

• Activate the EMS system
• Evacuate the area of exposure
• Remove all exposed clothing and seal it in a plastic bag, if available
• If possible, wash body and hair thoroughly with soap and water to remove any remaining radioactive material
• Dry and wrap the affected areas with a towel or blanket
• Monitor victim’s ABC’s and treat for shock

NOTE: If symptoms occur during or after medical radiation treatments, notify physician or seek medical treatment. Handle affected areas gently. Treat symptoms or illnesses as advised by physician.

Front 152

Electrical current and vehicles

Back 152

If peace officers respond to calls where live power lines have fallen onto a vehicle, they should:
• not touch the lines or any part of the vehicle
• instruct the occupants to remain in the vehicle
• wait for the utility company to turn off the power before taking any action

Occupants should not be told to leave the vehicle unless life-threatening circumstances exist (e.g., vehicle fire).

Front 153

Radiation sickness

Back 153

Radiation sickness is illness and symptoms resulting from excessive exposure to radiation, whether that exposure is accidental or intentional (as in radiation therapy).

Radiation sickness results when humans are exposed to excessive doses of ionizing radiation. Radiation exposure can occur as a single large exposure (acute), or a series of small exposures spread over time (chronic).

Radiation sickness is generally associated with acute exposure and has a characteristic set of symptoms that appear in an orderly fashion. Chronic exposure is usually associated with delayed medical problems such as cancer and premature aging, which may happen over a long period of time.

The severity of symptoms and illness depends on the type and amount of radiation, the duration of the exposure, and the body areas exposed. Symptoms of radiation sickness usually do not occur immediately following exposure.

Front 154

Radiation sickness - signs and symptoms

Back 154

The signs and symptoms of radiation sickness may include:
• Nausea and vomiting
• Diarrhea
• Skin burns (radio dermatitis)
• Weakness
• Fatigue
• Loss of appetite

• Fainting
• Dehydration
• Inflammation (swelling, redness and tenderness) of tissues
• Bleeding from nose, mouth, gums and rectum
• Low red blood cell count (anemia)
• Hair loss

Front 155

Radiation sickness - acute exposure

Back 155

In most cases, a large single dose of radiation can cause both immediate and delayed effects. Acute exposure, if large enough, can cause rapid development of radiation sickness that may include bone marrow damage, gastrointestinal disorders, bacterial infections, hemorrhaging, anemia and loss of body fluids.

Delayed effects can include cataracts, temporary infertility and cancer. Extremely high levels of acute radiation exposure can result in death with in a few hours, days or weeks depending on the dose.

Front 156

Radiation sickness - chronic exposure

Back 156

Chronic radiation exposure often produces effects that can be observed within weeks after the initial exposure. However, signs and symptoms of chronic radiation exposure may not show up until years later, or they may not develop at all.

Chronic exposure may increase your risk of cancer, precancerous lesions, benign tumors, cataracts, skin changes and congenital defects.

Front 157

Radiation sickness - first aid

Back 157

ONLY PROVIDE MEDICAL CARE IF YOU HAVE APPROPRIATE PROTECTIVE GEAR TO PREVENT POSSIBLE CONTAMINATION.

Front 158

Cardiac emergencies

Back 158

A cardiac emergency can range from a victim experiencing shortness of breath or palpitations to full cardiac arrest. Swift action is necessary on the part of peace officers to prevent death or permanent neurological injury.

Front 159

Heart attack

Back 159

Heart attack is a common term describing minor to severe conditions. Minor conditions include blockage of blood or lack of oxygen to heart tissue, with varying levels of pain. If the victim does not receive appropriate care immediately, the victim’s chances of survival are greatly reduced.

Front 160

Coronary artery disease (CAD)

Back 160

Coronary artery disease (CAD) (often referred to as coronary heart disease) is a disease where fatty deposits build up in the walls of the arteries that feed the heart’s muscle. If an artery becomes blocked, the heart muscle will be deprived of blood and oxygen.

Front 161

Cardiac emergencies - other causes

Back 161

Cardiac arrest may also be caused by:
• drowning
• electrocution
• suffocation
• choking
• drug overdose
• allergic reaction
• shock

Front 162

Cardiac emergencies - indicators

Back 162

Front 163

Cardiac emergencies - first aid

Back 163

Although the indicators of a cardiac emergency resemble the indicators of a number of other medical conditions (e.g., heartburn), peace officers should always first assume that a cardiac emergency exists, activate the EMS system (if not already activated), and take appropriate first aid measures.

Assessment
• Conduct primary and secondary surveys

Treatment
• Place the victim in a comfortable position (e.g., seated, supine, etc.)
• Keep the victim calm and still (even if the person denies indicators of a heart attack)
• Provide care to prevent shock
• Maintain victim’s body temperature
• Continue to monitor victim and provide reassurance until EMS personnel arrive

Front 164

Cardiac emergencies - medications

Back 164

Some victims with existing cardiac conditions may be taking prescription medications for that condition. Unless authorized and trained, peace officers should never administer any medications, prescribed or otherwise.

If victims are oriented enough to ask for or decide they need their prescribed medication, peace officers should allow a victim to take them. Peace officers may assist the victim if required (i.e., removing medication from its container and placing it in the victim’s hand).

Front 165

Respiratory emergencies

Back 165

Respiratory emergencies may range from victims who are having breathing difficulty, but nevertheless are breathing adequately, to victims who are not able to breathe at a level that will sustain life.

Front 166

Normal breathing rate

Back 166

Adult (puberty and older)
12-20 breaths/minute

Child (1year to puberty)
15-30 breaths/minute

Infant (newborn to 1 year)
25-50 breaths/minute

Front 167

Causes of inadequate breathing

Back 167

There are numerous possible causes that could lead to inadequate breathing and potential respiratory arrest (when breathing stops completely), including:
• existing illness (e.g., emphysema, asthma)
• allergic reaction (causing swelling of the throat)
• cardiac emergency
• drowning
• suffocation
• obstructed airway
• body positioning that restricts breathing (i.e., positional asphyxia)
• drug overdose
• hyperventilation

Front 168

Respiratory emergencies - indicators

Back 168

Front 169

Respiratory emergencies - first aid

Back 169

Assessment
• Conduct primary and secondary surveys

Treatment

• Activate EMS system
• Place the victim in a position of comfort (e.g., seated, supine, etc.)
• If victim is unconscious, place in the recovery position, if appropriate
• Keep the victim calm and still
• Allow the victim to take prescribed medications (e.g., inhaler)
• Loosen any restrictive clothing
• Provide care to prevent shock
• Continue to monitor victim and provide reassurance
• Be prepared to begin rescue breathing if necessary

Front 170

Seizure

Back 170

A seizure is the result of a surge of energy through the brain.

Instead of discharging electrical energy in a controlled manner, the brain cells continue firing, causing massive involuntary contractions of muscles and possible unconsciousness.

If only part of the brain is affected, it may cloud awareness, block normal communication, and produce a variety of undirected, unorganized movements

Front 171

Seizure - indicators

Back 171

Indicators of a seizure may include:
• staring spells
• disorientation
• lethargy
• slurred speech
• staggering or impaired gait
• tic-like movements
• rhythmic movements of the head (e.g., jerking uncontrollably)
• purposeless sounds and body movements
• dropping of the head
• lack of response
• eyes rolling upward
• lip smacking, chewing, or swallowing movements
• partial or complete loss of consciousness
• picking at clothing
• bluish skin tone
• urination

Front 172

Seizure - first aid

Back 172

Activate EMS

Treatment
• Do not restrain them
• Move objects out of the way which could harm them
• Cushion the person’s head
• Keep uninvolved people away
• Never put any object in the mouth

Post seizure assessment
• Conduct primary assessment
• Consider cervical spine stabilization
• Conduct secondary assessment

After the seizure has ended, individuals may experience a period of post-seizure confusion.

Peace officers should remain with the individual until the individual is reoriented to the surroundings and victim is transferred to equal or higher level of care.

Look for medical alert identification, place victim in the recovery position and care for any injuries that occurred during the seizure.

NOTE: Example questions to ask victim for orientation purposes are person, place, time, and event.

NOTE: Convulsions, confusion, and episodes of agitated behavior during an episode should not be perceived as deliberate hostility or resistance to the officer.

Front 173

Stroke

Back 173

A victim experiences a stroke (i.e., cerebrovascular accident (CVA)) when an artery providing blood to the brain is blocked. A stroke can also be caused by a ruptured blood vessel in the brain creating pressure on brain tissues.

Front 174

Stroke - indicators

Back 174

Front 175

Stroke - first aid

Back 175

Assessment
• Conduct primary and secondary surveys
• Activate the EMS system (if not already activated)

Treatment
• If conscious, elevate head and shoulders slightly (semi-sitting position)
• If unconscious, and appropriate, place in recovery position on affected side
• Continue to monitor victim
• Maintain an open airway
• Reassure victim
• Take appropriate actions to prevent shock
• Protect any numb or paralyzed areas from possible injury
• Do not give victim anything by mouth

Front 176

Diabetic emergencies

Back 176

The basic source of energy within the human cell is glucose. Glucose is circulated throughout the body in the bloodstream. In order for glucose to pass from the bloodstream into the body’s cells, insulin, a hormone produced by the pancreas, must be present. An imbalance of insulin in the body and glucose in the bloodstream can lead to life-threatening conditions.

Front 177

Glucose

Back 177

basic source of energy within the human cell

Front 178

Insulin

Back 178

hormone produced by the pancreas,

Front 179

Diabetes

Back 179

Diabetes is a condition brought on when the body does not produce a sufficient amount of insulin. Diabetes can occur at any age.

Front 180

Diabetic emergencies - 2 dangerous conditions

Back 180

An improper level of insulin in the body can lead to two potentially dangerous conditions: insulin shock (hypoglycemia) and diabetic coma (hyperglycemia).

Front 181

Hypoglycemia

Back 181

Insulin shock

Onset:

• Can come on suddenly
• More common

Skin:

• Pale, cold, moist, clammy
• Profuse perspiration

Breathing:

• Otherwise normal breathing

Mental status:

• Hostile or aggressive behavior
• Fainting, seizure
• May appear intoxicated

Pulse:

• Rapid pulse

Other:

• Dizziness, headache
• Excessive hunger
• Drooling
• Nausea or vomiting

Front 182

Hyperglycemia

Back 182

Diabetic coma

Onset:

• Usually slow onset

Skin:

• Red, warm, dry

Breathing:

• Labored breathing
• Breath has sickly sweet (fruity) smell

Mental status:

• Decreased level of consciousness
• Restlessness
• Confusion
• May appear intoxicated

Pulse:

• Weak, rapid pulse

Other:

• Dry mouth, intense thirst
• Excessive hunger
• Excessive urination
• Abdominal pain, vomiting
• Sunken eyes

Front 183

Diabetic emergency vs. other conditions

Back 183

There are a number of indicators of a diabetic emergency that are similar to indications of alcohol intoxication or substance abuse.
• Aggressiveness
• Combativeness
• Uncooperative behavior
• Confusion, dazed appearance
• Decreased level of consciousness
• Impaired motor skills
Peace officers should not assume that a person exhibiting these indicators is intoxicated without further questioning and assessment.

Front 184

Diabetic emergencies - first aid

Back 184

Because it can be extremely dangerous and life-threatening if left untreated, a possible diabetic emergency must be thoroughly assessed and first aid measures taken immediately.

Along with activating the EMS system (if not already activated) peace officers should take the following first aid measures.

Assessment
• Ask questions to determine if victim has exhibited any indications of a potential diabetic emergency
• Look for medical alert jewelry or other indicators that the person may be diabetic (e.g., wallet identification card, oral medications, insulin in the refrigerator, etc.)
• Conduct primary and secondary surveys

Treatment
• If unconscious:
- place victim in recovery position, if appropriate
- do not attempt to give the victim anything by mouth
• If conscious and alert
- place victim in a position of comfort
- give the victim oral glucose
• Provide reassurance to the victim
• Continue to monitor the victim
• Take appropriate measures to prevent shock

NOTE: Types of oral glucose include:
- table sugar (not a sugar substitute) dissolved in water
- orange juice
- honey
- hard candy placed under the tongue

Front 185

Poison

Back 185

A poison is any substance introduced to the body that causes damage.

Front 186

Poison identification

Back 186

Children are the most common victims of poisoning. Adults may become victims of poisons from their environment as well as by overdoses of medications or substance abuse

Peace officers should attempt to determine:
• what substance or combination of substances is involved
• when was the victim exposed to the substance
• how much of the substance the victim was exposed to
• length of time the victim was exposed
• what effects the victim has experienced since the exposure
• what if any interventions others (e.g., family members, friends, etc.) have already taken
Peace officers should also look for indications of:
- medical and/or mental problems (e.g., bottles of medications, medical alert jewelry, etc.)
- existence of injuries
- evidence of alcohol or illegal drug use (e.g., drug paraphernalia, bottles, etc.)

Front 187

Poison - Peace officer safety

Back 187

Peace officers responding to medical emergencies involving poisons should take appropriate precautions against exposing themselves to the substance as well.
Officers should:
• not enter any environment containing poisonous gases or fumes until the area has been well ventilated
• use care when handling hypodermic needles or other sharp objects that may be contaminated
• not take any actions that could cause them to become victim’s of the substance
• follow agency policies and procedures

Front 188

Poison - Manner of exposure

Back 188

Ingestion
• Swallowing the substance

Examples:
• Medications
• Illegal drugs
• Alcohol
• Household or industrial chemicals
• Petroleum products
• Improperly prepared food

Inhalation
• Breathing in the substance in the form of gases, vapors, or fine sprays

Examples:
• Carbon monoxide
• Household or industrial chemicals
• Petroleum products

Absorption
• Taking in the substance through unbroken skin or membranes

Examples:
• Insecticides
• Agricultural chemicals
• Plant materials (e.g., poison ivy)

Injection
• Through deliberate or accidental punctures to the skin

Examples:
• Illegal drugs
• Medications

Front 189

Poison - indicators

Back 189

Ingestion
• Possible burns around the mouth or hands
• Unusual stains or colors on skin or mouth
• Strong odor on victim’s breath
• Difficulty breathing
• Sudden unexplained, severe illness
• Vomiting, abdominal cramping

Inhalation
• Dizziness
• Headache
• Nausea, vomiting, abdominal cramping

Absorption
• Itching
• Redness, rash, or some other form of skin reaction
• Increased skin temperature
• Headache
• Eye irritation
• Allergic reaction

Injection
• Swelling at injection site
• Redness of affected skin

NOTE: Some individuals may have a systemic (i.e., whole body) reaction when exposed to certain substances. One symptom of a systemic reaction is anaphylactic shock, a condition that causes the airway to swell, making breathing difficult if not impossible.

Front 190

Poison - first aid

Back 190

Activate EMS

Assessment
• Determine the victim’s level of consciousness
• Conduct primary and secondary assessments (Look for signs of swelling, redness, puncture sites, etc.)
• Attempt to identify the poisonous substance

Treatment
• If necessary, remove victim from source of poison (gases, vapors, plant material, etc.), if done safely
• If victim is unconscious, place in a recovery position, if appropriate
• Contact poison control center for treatment advice
• If exposure has been through absorption:
- flood affected areas with water
- wash affected areas with soap and water
• Take precautions to prevent shock
• Continue to monitor victim

Front 191

Alcohol / substance abuse

Back 191

There are a number of indicators specific to poisonings caused by alcohol and/or substance abuse, of which peace officers should be aware.

Indications of withdrawal from alcohol or drugs can include, but are not limited to:
• confusion
• hallucinations or psychotic behavior
• blackouts (e.g., loss of short term memory)
• altered mental status
• tremors or shaking
• profuse sweating
• increased pulse and breathing rates

Certain types of drug abuse can also be associated with violent outbursts and aggressive behavior. Peace officers should take necessary precautions to protect themselves and others when assisting an individual suspected of drug or alcohol abuse

Front 192

Hypothermia

Back 192

Hypothermia occurs when the body’s internal temperature drops to the point where body systems are affected.

Hypothermia can range from mild to severe due to a number of factors:
• length of exposure to cold temperatures
• condition of victim’s clothing (wet or dry)
• age of victim (elderly and very young are more susceptible)
• existence of underlying illnesses or disorders (e.g., circulatory problems, infections/fever)
• traumatic injury (e.g., head injuries, etc.)
• alcohol consumption

NOTE: Hypothermia can develop even in temperatures that are above freezing.

Front 193

Hypothermia - indicators

Back 193

Mild-Moderate Hypothermia
• Violent shivering
• Numbness
• Fatigue
• Forgetfulness
• Confusion
• Cold skin
• Loss of motor coordination
• Rapid breathing and pulse

Severe Hypothermia
• Lack of shivering
• Rigid muscles and joints
• Slow shallow breathing
• Irregular, weak, slow pulse
• Dilated pupils
• Decreased level of consciousness leading to unconsciousness
• Unwilling or unable to do simple activities
• Slurred speech
• Blue-grey skin color

NOTE: Unconscious victims with hypothermia may appear clinically dead due to stiffness and extremely low pulse and respiration rates.

Front 194

Hypothermia - First aid

Back 194

Mild-Moderate Hypothermia
• Move victim to a warm environment (e.g., patrol vehicle)
• Remove any wet clothing and replace with dry
• Re-warm victim slowly
• Provide care to prevent shock
• Monitor the victim
• If victim can swallow easily, give warm liquids (e.g., water)
• Do not give alcoholic or caffeinated beverages, or nicotine because they can further hinder circulation
• Keep the victim moving to increase circulation

Severe Hypothermia
• Determine the victim’s level of consciousness
• Conduct primary and secondary surveys
• If victim has a pulse but is not breathing, begin rescue breathing
• If victim has no pulse and is not breathing, begin CPR

NOTE: If the victim cannot be moved, take necessary measures to keep the victim from losing more body heat (e.g., wrap in blankets, etc.).

Front 195

Frostbite

Back 195

Exposure to cold temperatures can also lead to cold-related injuries to parts of the body. Injuries that are the result of cold or freezing tissue include frostnip and frostbite.

Areas most commonly affected by frostbite are:
• ears
• face and nose
• hands
• feet and toes

Front 196

Frostnip - first aid

Back 196

Frostnip

Indicators
• Superficial freezing of skin’s outer layer
• Numbness
• Pale skin color
• Skin feels flexible to the touch
• Tingling or burning sensation to the area upon warming

First Aid
• Remove victim from source of cold
• Remove/loosen any clothing that may restrict circulation to the area

Front 197

Frostbite - first aid

Back 197

Indicators:

• Freezing of tissue below the skin’s surface
• Skin feels stiff to the touch
• Pale, grey-yellow, grey-blue, waxy, blotchy skin color
• Pain or aching sensation to the area upon warming

First aid
• Immobilize and protect the area
• Wrap area in dry, loose bandage
- Wrap each digit separately
• Allow area to rewarm slowly
• Provide care to prevent shock

NOTE: Do not rub the affected area. Damage may be caused by ice crystals that have formed below the surface of the skin.

NOTE: Do not allow the frozen area to refreeze after warming. Refreezing can cause extensive tissue damage.

Front 198

Heat cramps

Back 198

If the body is unable to get rid of excess heat, the body’s internal temperature can rise to a level that can cause pain, organ damage, or even death.

Heat cramps can strike when the body loses too much salt due to prolonged perspiration.

The person will have a normal body temperature and be able to think clearly.

Indicators:

• Painful muscle spasms usually in the legs or abdomen
• Lightheadedness
• Weakness

Front 199

Heat exhaustion

Back 199

Heat exhaustion is a condition that is more serious than heat cramps. It is a form of shock that can occur when the body becomes dehydrated. Once a person who is exposed to heat becomes thirsty, that person may already be suffering from dehydration.

The person will have a normal body temperature and be able to think clearly.

Indicators:

• Profuse sweating
• Dizziness
• Headache
• Pale, clammy skin
• Rapid pulse
• Weakness
• Nausea and vomiting

Front 200

Heat cramps / exhaustion - first aid

Back 200

• Remove victim from source of heat
• Have the victim rest
• Massage cramped muscles
• Provide fluids in small amounts
• Do not give alcohol or caffeinated beverages

Front 201

Heat stroke

Back 201

heat exhaustion is not recognized and treated promptly, heat stroke may set in. Heat stroke occurs when the body’s internal temperature rises abnormally high. Heat stroke is a life-threatening condition requiring immediate attention

Indicators:

• Red, hot, dry skin
• Rapid, irregular pulse
• Shallow breathing
• Confusion
• Weakness
• Possible seizures and/or unconsciousness

Front 202

Heat stroke - first aid

Back 202

• Activate the EMS system (if not already done)
• Continue to monitor victim
• Remove victim from source of heat
• Loosen or remove victim’s clothing
• Cool victim’s body as rapidly as possible by:
- dousing the person with cool water
- wrapping the person in a wet sheet or blanket
- placing an ice pack wrapped in a towel on the person’s neck, groin, or armpits
• Provide care to prevent shock

NOTE: Heat stroke can affect children or the elderly who have circulatory problems, even when they are not exposed to extreme heat.

NOTE: Dry hot conditions, versus heat with high humidity, can bring on less fatigue. For this reason, individuals may remain in a dry hot environment longer and become more susceptible to heat related illnesses

Front 203

Stings and Bites

Back 203

Insect stings, spider bites, and snake bites can all be sources of injected toxins. Certain insects, spiders, and snakes can inject toxins that cause serious consequences if not treated rapidly.

Front 204

Anaphylaxis (i.e., anaphylactic shock)

Back 204

Anaphylaxis (i.e., anaphylactic shock) is a severe, life-threatening allergic reaction caused by exposure to certain allergens.

Exposure to an allergen
(via insect stings, foods, etc.,) can cause:
• blood vessels to dilate leading to a sudden drop in blood pressure
• swelling of the tissues that line the respiratory system causing an obstructed airway

Epinephrine is a hormone produced by the body. When administered as a medication soon after exposure, epinephrine will constrict blood vessels and dilate the bronchioles helping to open the victim’s airway.

Individuals who are subject to anaphylaxis often carry prescription epinephrine to use if such a reaction occurs.

Front 205

Epinephrine

Back 205

Epinephrine is a hormone produced by the body. When administered as a medication soon after exposure, epinephrine will constrict blood vessels and dilate the bronchioles helping to open the victim’s airway.
Individuals who are subject to anaphylaxis often carry prescription epinephrine to use if such a reaction occurs.

Front 206

Insect stings and bites - usual reaction and first aid

Back 206

Usual reaction

• Local swelling
• Minor pain
• Itching

First aid
• Remove stinger by scraping with firm object (Do not attempt to pull out with tweezers.)
• Wash area with soap and water
• Apply ice to reduce swelling and slow the rate of toxin absorption

Front 207

Insect stings and bites - allergic reaction and first aid

Back 207

Allergic reaction

• Itching

• Burning sensation
• Hives
• Swollen lips and tongue
• Difficulty breathing
• Respiratory failure

First aid
• Assist victim in taking prescribed epinephrine
• Activate the EMS system
• Monitor victim
• Take precautions to prevent shock
• Be prepared to use rescue breathing or CPR if necessary

Front 208

Marine life stings - indicators and first aid

Back 208

Poisoning from marine life is generally caused by the stings or puncture wounds of poisonous organisms (e.g., jellyfish, sea nettle, sea anemone, coral, Portuguese Man-O-War, stingray, sea urchin, etc.).

• Pain
• Swelling
• Discoloration

First aid
• Wash area with soap and water
• Apply heat (not cold) to deactivate venom enzymes
• Apply dressing to puncture wounds if necessary
• Monitor the victim
• If an allergic reaction (i.e., anaphylaxis) is suspected:
- assist victim in taking prescribed epinephrine if they have it
- activate the EMS system
- take precautions to prevent shock
- be prepared to use rescue breathing or CPR if necessary

Front 209

Spider bites - black widow

Back 209

Black Widow
Marked by a read, hourglass shaped spot on its abdomen

• Dull pain within 15 minutes of bite
• Headache
• Chills
• Sweating
• Dizziness
• Nausea and vomiting

Front 210

Spider bites - brown recluse

Back 210

Brown Recluse
Marked by a brown or purplish violin-shaped mark on its back

• Painless ulcer at site where bitten
• Ulcer gradually increases in size (bull’s-eye appearance)
• Chills
• Aches
• Nausea

Front 211

Spider bites - first aid

Back 211

• Wash site with soap and water
• Apply ice to reduce swelling and slow the rate of venom absorption
• Monitor victim
• Have victim seek medical treatment
• Treat for shock

Front 212

Snake bites - indicators and first aid

Back 212

Indicators
• Pain, redness, and swelling which begins quickly after bite
• Fang marks
• Shortness of breath
• Tingling around victim’s mouth
• Bloody vomiting (appearance of coffee grounds)
• Shock
• Coma

First aid
• Keep the victim calm and quiet
• Place the affected area in a neutral position
• Immobilize the affected area (use splints if necessary)
• Do not attempt to suck the venom from the bite
• Do not cut the area
• Take measures to prevent shock
• Seek medical attention
• Attempt to identify the snake

Front 213

Animal and human bites - indicators and first aid

Back 213

Indicators
• Pain, redness, swelling at the site
• Damage can range from puncture wound of skin to severe laceration or avulsion of tissue

First aid
• Control bleeding if necessary
• Wash site with soap and water
• Cover with clean dry dressing
• Take measures to prevent shock
• Monitor victim
• Seek medical attention

NOTE: If possible, an attempt should be made to identify the circumstances that led to the bite and locate the animal for rabies testing

Front 214

Childbirth - Who can deliver a baby

Back 214

Only the woman herself can deliver her infant

Front 215

Childbirth - First responder role

Back 215

If called upon to assist during normal childbirth, it is the peace officer’s role to activate the EMS system, determine if the woman can be transported prior to the birth, and provide support as the woman delivers the infant.

Front 216

Childbirth - First responder actions

Back 216

The First Responder should build a rapport by introducing themselves to the mother. First responders should:
• use Personnel Protective Equipment (PPE) properly
• prevent explosive delivery with gentle pressure on the delivery head
• use a firm grip on the infant as newborns are slippery
• clear airway
• dry infant quickly and keep warn
• keep new born at the same level as the mother
• deliver the placenta and save it for transport with mother

Front 217

Childbirth - transport

Back 217

One of the first decisions the assisting peace officer will need to make is whether or not to arrange for transport to a medical facility prior to delivery of the infant. The woman can be safely transported only if she is in the first stage of labor (not straining, contractions are greater than 5 minutes apart, no signs of crowning).

NOTE: If transport is safe, continue to monitor the woman while waiting for EMTs to arrive at the scene.

Front 218

Childbirth - Imminent birth

Back 218

If any of the following conditions exist, the mother is entering the second stage of labor and birth may be imminent. The woman should not be transported.

Indications that birth may be imminent include:
• contractions that are occurring less than two minutes apart (five minutes if second or subsequent birth)
• the woman feels an urgent need to bear down
• crowning is present
• the amniotic sac has ruptured (i.e., the woman’s water has broken)

Front 219

Childbirth - complications - excessive bleeding

Back 219

Indicators
• Profuse bleeding from vagina
• Mother may or may not experience abdominal pain

First Aid
• Take appropriate measures to prevent shock
• Absorb blood with towels or pads, apply more as necessary
• Arrange for immediate transfer to a medical facility

Front 220

Childbirth - complications - transportation considerations

Back 220

Should any of the following conditions exist, immediately transport mother to nearest medical facility:
• Limb presentation
• Breach presentation (buttocks first)
• Cord presentation
• Delayed delivery
In preparing for transportation, ensure mother is in the prone knee to chest position.

Front 221

Childbirth - newborn fails to breathe

Back 221

A newborn should begin breathing on its own within 30 seconds after birth. If it fails to breathe, rubbing the infant’s back or tapping the infant’s feet may stimulate spontaneous respiration.

If the newborn still fails to breathe on its own, rapid first aid measures are required. The following actions should be taken:
• Check for a brachial pulse
• If there is a pulse, begin rescue breathing
• If there is no pulse, begin CPR immediately

NOTE: Use caution not over extend the infant’s neck. This could close the airway or damage the infant’s trachea. Use reduced volume (a cheekful of air) for breaths being careful not to over inflate the infant’s lungs.