• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/188

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

188 Cards in this Set

  • Front
  • Back
What makes a good first aid Provider
• Has technical knowledge by virtue of their training and learning. • Holds a current first aid certificate. • Is able to use their knowledge to assess the situation and administer first aid as needed. • Is able to react confidently under pressure. • Presents and maintains a professional appearance.
First aid provider responsibility provider?
A first aid provider's responsibility is to take charge of an emergency situation through definitive command and confident action. • Survey the scene • Evaluate signs and symptoms • Gather information about the incident and the injured • Be professional • Prompt and effective care • Communicate with appropriate personnel • Transport the injured person to medical assistance • Communicate and report incident details
The body
The human body is a complex organism composed of billions of cells working together in an organized manner for the benefit of the whole system. The cell is the fundamental unit of structure and function. Cells are grouped into tissues, tissues into organs, and organs are grouped into systems. The entire collection of systems becomes the organism known as a human being.
Anatomy
Anatomy is the study of the body's structure describing the size, shape, construction and positions of its various parts.
Midline
an imaginary line dividing the body into two mirror image halves.
Lateral
body parts farthest from the midline.
Medial
body parts closer to the midline.
Superior
a part of the body closer to the head
Inferior
a body part towards the feet.
Anterior
anything towards the front of the body.
Posterior
anything towards the back of the body.
Proximal
closer to the heart.
Distal
farther from the heart.
Prone
lying face down on the chest.
Semi-Prone
(also known as three- quarters prone or recovery position): lying face down, on one side.
Supine
Lying face up on the back.
Bones
There are 206 bones in the normal skeleton. They: • Protect internal body organs. • Provide shape or a framework to keep the body supported. • Produce red blood cells. • Provide storage for mineral salts, such as calcium.
Shoulder girdle
The shoulder girdle is composed of the: • clavicles (collarbones), and • scapulas (shoulder blades).
Spine and vertebrae
The spine is the principal support of the body: ribs extend from it, and the rest of the skeleton is directly or indirectly attached to it. The spine is composed of 33 bones, called vertebrae. . Individual vertebrae are separated by discs. They serve as shock absorbers and allow for limited movement. The spinal column provides protection for the spinal cord.
Vertebrae
Vertebrae as classified from top-to-bottom are: • Cervical (7) • Thoracic (12) • Lumbar (5) • Sacral (5) • Coccyx (4)
Rib attachment, spinal column, sternum and xiphoid process
Every rib is attached to the spinal column at the thoracic vertebrae. The highest seven pairs of ribs are attached to the sternum by cartilage (costochondal junction). The next three pairs of ribs are joined by a common cartilage attached to the seventh rib cartilage, which is in turn attached to the base of the sternum.The lowest two pairs of ribs are floating ribs. They are the shortest ribs and have no attachment to the sternum. The sternum - breast bone - forms the middle part of the front of the rib cage. The xiphoid process forms the inferior end of the sternum.
Upper extremities
The upper extremities consist of the: • upper arms, • lower arms (forearms), and • wrists, hands and fingers.
Upper Arm
single long bone called the humerus.
Lower Arm
Consists of two long bones: • the radius, on the thumb side of the lower arm, and • the ulna, on the little finger side.
Wrists, Hands and Fingers
Composed of short and irregular bones. Respectively, they are the: • carpal, • metacarpal, and • phalanges.
Pelvis
The pelvis serves as an attachment for muscles, supports body weight and protects major organs. The pelvis is composed of two pelvic bones. . The bones are held together in the front and connected to the sacrum in the back by very strong ligaments.
Three Parts of the Pelvis
. • the ilium, • the ischium, • the pubis.
Lower extremities
The lower extremities consist of the: • thigh bones (femurs), • knee caps (patellas), • long lower leg bones 􏰀 (tibias and fibulas), and • ankles, feet and toes.
Thigh bones
. (femur) is the longest bone in the body and forms the upper leg. Proximally, its head fits into a socket in the pelvis to form the hip joint. The shaft of the bone is strong and surrounded by heavy muscles. Distally, the femur broadens to form the upper part of the knee joint.
Knee Caps
. The knee cap (patella) is a flat, triangular shaped bone. The patella lies in front of the knee joint and helps protect it.
Long Lower leg Bones
. The lower leg bones (tibia and fibula) are the long bones that form the lower leg. The fibula is the smaller bone which distally forms the lateral prominence of the ankle joint.
Tibia
. The tibia is the larger, stronger bone which forms the lower half of the knee joint, the shin and the medial prominence of ankle joint.
Ankles, Feet and Toes are made of?
• tarsals, • metatarsals, and • phalanges.
The respiratory system
The respiratory system is responsible for the exchange of gases between the body and the environment. In conjunction with the circulatory system, it supplies oxygen to the body tissues, and helps in the removal of carbon dioxide, which is a waste product, from the body's tissues.
Normal respiration requires five conditions?
1. A supply of normal air 2. A clear air way 3. The mechanical bellows function of the rib cage and diaphragm must be intact and contain at least one functioning lung 4. The control system, including the brain, must be intact and able to respond to changing carbon dioxide levels in the blood stream 5. An adequate blood supply with proper circulation by the heart
Mechanics of breathing (Long Answer)
The exchange of oxygen and carbon dioxide in the body's cells and the passage of air in and out of the lungs is called respiration. Breathing in is called inspiration or inhalation; breathing out is called expiration or exhalation. Breathing is an active function that requires muscle action. Without brain function no breathing is possible except by an artificial method. The act of breathing may be compared to the action of a bellows with a partially filled balloon inside. The rib cage and diaphragm act as the bellows. The lungs respond passively, acting as the partially filled balloon inside the bellows. The lungs are surrounded by a double- layered sac called the pleura. The pleura's outer layer is attached to the ribs and completely lines the chest cavity. The inner layer surrounds and is attached to the lungs. Maintaining a vacuum in the space between these layers - the pleural space - is critical to respiration.
Inspiration (Long Answer)
Inspiration (inhalation) is an active function. The rib muscles contract raising the ribs and expanding the chest. The diaphragm muscle also contracts and flattens out resulting in an enlarged chest cavity. As the chest cage becomes larger, the lungs expand. Of the air exchanged in the lungs, two- thirds is caused by the movement of the diaphragm muscle, one-third by the muscles that move the ribs.
Inspiration (Short Answer)
During inspiration: 1. The chest cavity enlarges. 2. The air pressure within the chest falls, and more air rushes into the lungs.
Expiration (Long Answer)
Expiration (exhalation) is a passive function and normally requires no muscular exertion. On expiration, the rib muscles and diaphragm relax, the chest contracts and air is expelled from the lungs. Any hole in the chest wall will destroy the vacuum inside and the lung will collapse because of its elastic nature and the effects of the pressure differential.
Signs of normal breathing (3 Things)
• the rise and fall of the chest or abdomen, • evidence of air moving in and out of the lungs, and • a regular rate and rhythm.
Average Resting respiratory Rates for various Ages
Infant (up to one year)………30 to 50 Toddler (one to four years)…20 to 30 Child (five to 12 years)………12 to 20 Adult…………………………..12 to 20
Arteries
The arteries are thick-walled, elastic vessels which carry blood away from the heart. The elastic nature of these vessels helps to even out the blood pressure between heart beats and also causes them to retract and constrict when severed.
Pulse (Long Answer)
The pulse is the pressure wave caused by the contraction of the heart which forces the blood through the arteries. The best points at which to feel the pulse are where the arteries lie near the surface of the body, and near a bone or hard surface against which pressure may be applied. The most frequent site for taking a pulse is the inside of the wrist using the radial artery. The most dependable site to take a pulse is either side of the larynx. The carotid artery can easily be felt here because it is very large and close to the heart. Pulse rates vary considerably as a result of different factors such as age, activity, emotional response, injury, physical conditioning, disease, medication, or environmental conditions.
Average resting pulse rate
Infant (up to one year)………80 to 160 Toddler (one to four years)….80 to 120 Child (five to 12 years)………60 to 110 Adult…………………………..60 to 100
Blood pressure (Long answer Part 2)
Blood pressure is usually referred to as the systolic value over the diastolic in millimetres of mercury. Blood pressure can vary considerably between individuals depending on the time of day it is measured, activity or emotions the individual is experiencing. A systolic pressure of at least 80 is assumed when a radial pulse can be felt, 70 with a femoral pulse, and 60 with a carotid pulse.
Blood pressure (Long answer Part 1)
At each heart contraction, the arteries expand and absorb the momentary increase in blood pressure. As the heart relaxes in preparation for another beat, the aortic valves close to prevent blood from flowing back to the heart chambers and the arterial walls spring back, forcing the blood through the body between contractions. In this way the arteries act as dampers on the pulsations and provide a steady flow of blood through the blood vessels. Because of this, there are actually two blood pressures within the blood vessels during one complete heartbeat: • The systolic or higher pressure upon ventricular contraction. • The diastolic or lower pressure during cardiac relaxation.
Personal concerns (Exposure to a transmissible infection?)
• Don't panic. • Attend to the patient's priorities. • Wash, bleed out and disinfect your wound immediately. • Remove yourself from the scene as soon as further help arrives to the scene. • Inform the patient that you have likely become exposed to each other's blood and exchange contact information. • Ask the patient discretely and privately whether he or she is known to have an infectious disease. Do not share this information with anyone not immediately involved in caring for the patient. • Contact an emergency physician immediately to explain the situation.
Universal precautions
• Wear disposable, single use, impermeable gloves when examining any patient or when in contact with body fluids. Examination gloves offer the best protection. If they are not available, leave your ski gloves on during treatment to avoid direct skin contact with body fluids. • Use a separate set of gloves for each patient to avoid cross-contamination. • Use a pocket face mask or other barrier type device wherever possible for assisted ventilations. • Keep sharp objects such as broken glass, pen knives, pins, and scissors, away from the scene. If this is unavoidable, handle them as little as possible and with extreme caution around bleeding individuals. Be sure everyone present is aware of where they are. • Dispose of bloody bandages in plastic bags and seal them. Soiled garments belonging to the injured person should likewise be placed in plastic bags, sealed and kept with the injured person. • Clean up blood and body fluids spilled at the scene using detergents where feasible. • Remove or cover bloody snow. • Wear eye goggles when blood and body fluids cannot be controlled, e.g. spurting blood from an injured vessel or vomiting. • If possible, wear a face mask that protects the nose and mouth.
Overview
The assessment process is your tool to: • ensure the safety of yourself and others, • get help when you need it, • rationally and accurately evaluate the severity of a person's injuries make prudent decisions about treatment and transportation Every situation is different but it is the same process every time. This will allow you to avoid hazards to yourself, the patient, and others who may be around. It will also allow you to get an initial sense of what has happened and how to manage the situation.
Evaluate the chest
Look for evidence of DCAP-BLS. At the chest also look for paradoxical movement ribs or segment of ribs moving differently. Where the chest normally expands during inspiration, a loosened segment will be drawn in. Where the chest normally deflates during expiration, the loosened segment will bulge. Feel the chest for evidence of, TIC. At the chest, also feel for subcutaneous emphysema, air bubbles under the skin -- which feel like puffed rice (Rice Krispies).
Evaluate the pelvis
Look for evidence of DCAP-BLS. Feel the pelvis for instability by first pushing the sides of the pelvis together above the widest part of the hips and then pushing back on the outer wings of the pelvis. The pelvis is an extremely strong, rigid structure. It takes a great deal of energy to do damage. Therefore, if the pelvis is fractured, it's a major injury. The vessels in and around the pelvis are large. Blood loss can be tremendous if they too are injured. Pelvic injury can also result in the rupturing of the bladder if it is full. Check for blood and wetness.
Pupil reaction
Examine to find whether the pupils are equal and reactive to light - PERL. Normally, pupils dilate (enlarge) in dimmer light and constrict (become smaller) in brighter light. Note that up to 10 per cent of normal individuals have unequal pupils. The pupils of the eyes are good indicators of the condition of the circulatory system and the brain. Normal eyes react to light equally and quickly. Perform the evaluation with a flashlight, if possible, or by putting a hand over an eye for a few seconds and removing it quickly. Do not shine a flashlight directly into the pupil. This is uncomfortable; shine the light from the side of the eye.
Pupil response “Equal and reactive” Possible causes?
Normal
Pupil response “Non-reactive” Possible causes?
Glass Eye or contact lens
Pupil response “Fixed and dilated” Possible causes?
Brain hypoxia
Pupil response “Unequal” Possible causes?
Head injury or stroke, congenital
Pupil response “Fixed and constricted” Possible causes?
Drug abuse or severe brain damage
Pupil response “Small, pinpoint” Possible causes?
Drug usage or disease
Pupil response “Change from constricted to fixed and dilated” Possible causes?
Worsening condition
Breathing rate/Respirations
Observe rate, depth and effort needed to breath. Note airway sounds while you check the breathing as per the primary assessment. The secondary assessment also checks the rate. Count the number of breaths/chest expansions in 15 seconds, then multiply by four.
Breathing Rate “None” Possible Causes?
Respiratory arrest
Breathing Rate “Slow (<10/min)” Possible Causes?
Stroke,Head injury, Overdose, Chest injury
Breathing Rate “Fast (>20/min)” Possible Causes?
Asthma Shortness of breath Chest injury Shock
Breathing Rate “Patterned” Possible Causes?
Head injury, Diabetic coma
Secondary assessment
The secondary assessment consists of four major parts: 1. Vital signs 2. A head-to-toe exam 3. Patient history 4. Documentation NB. This is an extensive section and should be read.
Evaluate PMS
pulse, motor response and sensation
Pulse
Pulse indicates circulation at the extremities. Apply a small amount of pressure to the toe or a spot of skin (above the ski boot) until the pressured area turns white. Capillary refill is the time it takes for the area to recover its normal colour. Normal refill time is less than two seconds in a healthy person. If capillary refill takes more than two or three seconds, it may be an early sign of shock or dehydration. Note that refill is delayed in cold environments.
Motor Response
Motor response shows whether a patient can move a foot if asked to do so. Ask the patient to move their foot or press against your hand.
Sensation
Sensation shows whether a patient can feel a touch or pain stimulus. Test for sensation by tapping on the bottom of their boot and asking if they can feel it.
Transportation decision
The decision whether you should transport immediately because you have a patient with a life-threatening condition (load and go), or whether the patient can be fully checked and treated prior to departure (stay and treat). NB. This is an extensive section and should be read.
Evaluate the lower extremities
Lower legs Check the lower extremities (knee, calf, ankle feet and toes). Look for evidence of DCAP-BLS. Feel for evidence of TIC. Use a two-handed technique to firmly squeeze all the way down the lower leg. If only one hand can be used, use the side of your thumb to press on the angular edge of the tibia all the way down its length. Use a similar technique to trace the fibula (outer side of the leg) down its length.
Multiple patients - triage
Triage (French for "sort") is the process of sorting patients based on the seriousness of their injuries. Use triage if there are numerous patients involved to determine who may need help and who needs to be transported in what order. Patients are quickly assigned one of four colour codes NB. This is an extensive section and should be read.
Acronym “START” (Triage)
Simple Triage and Rapid Treatment
Red
HIGH AKA Critical Life-threatening injuries. These patients have compromised breathing or circulation or LOC. They require immediate treatment and transportation.
Yellow
MEDIUM AKA Serious Not immediately life-threatening. These patients have patent ABCs, no obvious signs of shock, and seem alert but are not likely walking. Any bleeds can be controlled. They require treatment but transport may be delayed.
Green
LOW AKA Minor May need treatment. These patients are walking and alert. Transport can be delayed with no detriment to the patient's outcome.
Black
NONE AKA Dead or non-salvageable These patients have no spontaneous breathing even with a repositioned airway.
Hypoxia
decrease in the level of oxygen available to the cells. be able to recognize the signs and symptoms that indicate the onset of hypoxia. The ultimate goal in treating hypoxia is to increase blood oxygen concentration and thus prevent the patient’s condition from deteriorating and developing shock, respiratory arrest or ultimately resulting in brain damage and death. NB. This is an extensive section and should be read.
As a cause of Hypoxia; Acronym “CRASH"
Cardiac Respiratory Altered level of consciousness Shock Head Injury
Oxygen equipment
Most oxygen equipment systems will consist of a tank, regulator, hose and face mask. • The oxygen tank will either be green or white, and should have a yellow diamond marker saying oxidiser. • A pressure regulator lowers the pressure from 2,000 psi (138 Bar) inside the tank to less than 50 psi 􏰀 (3.45 Bar). • A hose and a face mask. A face mask can deliver up to 50 per cent oxygen concentration.
Regulator and flowmeter
The flowmeter normally controls the output of oxygen to be delivered from one to 15 litres per minute (lpm).
Methods and principles used in cardiopulmonary resuscitation (CPR)
NB. This is an extensive section and should be read.
Airway obstructions
here are two classes of airway obstructions: • mild airway obstructions, and • severe airway obstructions.
Mild airway obstruction
. Airway obstruction caused by a foreign object usually occurs when a patient is eating or chewing. The patient may use the universal distress signal to indicate an airway obstruction: clutching their hands to their throat. They may begin to turn blue and will obviously be very frightened. Ask the patient, “Are you choking?”
Mild airway obstruction Signs and Syptoms
Determine if the patient is suffering from a mild airway obstruction by looking for the following signs and symptoms: • the ability to forcibly cough, and • wheezing between coughs.
Mild airway obstruction Treatment
1. Prevent further injury; 2. Identify yourself as a trained first aider; 3. Offer assistance and ask permission; 4. Do not attempt abdominal thrusts; 5. Never interfere with the patient’s efforts to clear the airway; 6. Stay with the patient until breathing is normal; 7. Monitor vital signs; 8. Encourage the patient to try and dislodge the object by coughing; 9. If the condition persists,activateEMS; 10.If the patient becomes unresponsive, treat the situation as a severe airway obstruction
Finger sweep
Finger sweep must be avoided unless you can see the object when opening the patient's mouth. This rule is applicable for the adult, child and the infant. Always be mindful that too hasty or forceful action may insert the obstruction more solidly. This is especially true of children and small-framed adults. Look first. Try to identify the obstruction visually 1. Check the mouth with at tongue jaw lift and finger sweep: a.Open the mouth. b.Grasp both the tongue and the lower jaw between the thumb and the fingers. c.Lift the mandible. d.Insert the index finger of the other hand down along the inside of the 2. Carefully scoop out the obstruction.
Severe airway obstruction
The inability to produce any sound indicates a severe airway obstruction and the need for immediate action. Without oxygen the patient may soon become unresponsive. Within four to six minutes brain damage may occur.
Severe airway obstruction; Signs and symptoms
• inability to speak, breathe or cough; • absence of chest movement or air exchange; and • increased cyanosis.
Abdominal thrusts/back blows- conscious adult or child
With the exception of positioning and applied force, abdominal thrusts and back blows are basically administered in the same fashion for both the adult and the child.
Ventilation
Ventilating is the action of exhaling breath from the first aider into the patient. When ventilating, and in order to minimize excess air going into the stomach (gastric distention), consider the size of the patient and limit the volume of air you exhale to what is required to make the chest clearly rise. In order to enable you to continue ventilating the patient for a period of time without hyperventilating, you must also consider the normal respiratory rates for the age group of the patient and your own. NB. This is an extensive section and should be read.
Ventilation Rate by Age
Groups (yr.) Rates Duration Volumes Infant one every three seconds (20/min.) one second until the chest clearly rises Child one every three seconds (20/min.) one second until the chest clearly rises Adult one every five seconds (20/min.) one second until the chest clearly rises
Pulse check
For an adult or child the most dependable site to take a pulse is the carotid artery (i.e. the outside base of the throat). It is usually quite accessible, very large and close to the heart. For an infant the most dependable site is at the brachial artery. The pulse check is only taught to trained responders.
Pulse Check Carotid Artery
• Place two or three of your fingers on the top centre of the patient's neck. • Slide your fingers to the side of the neck (approximately one inch) until your fingers rest on the neck muscle close to the trachea.
Pulse Check Brachial Artery
• Place two or three of your fingers along the humerus, between the biceps and triceps muscles. • Pulse check verifications within a sequence should not take more than 10 seconds for the initial check and no more than 10 seconds every other time.
Recognition of warning signs (cardiac event)
• Not all heart diseases and strokes can be prevented. The symptoms of heart attack and stroke must be recognized early enough, so that proper help can be obtained. • Common delays to treatment include: denial, lack of recognition of symptoms, and not knowing what action to take.
Open chest injuries
In penetration injuries of the chest wall, air can enter the interpleural space from the outside, causing the lung to collapse. Air moving back and forth through the chest wall results in what is often called a sucking chest wound because of the sucking sound during inspiration. Important notes If the chest wall is punctured, air can enter the pleural cavity and the patient can develop a pneumothorax If open chest injuries are not treated properly, they can result in tension pneumothorax.
Open chest Injuries; Signs and Symptoms
• increasing difficulty in breathing, • frothy blood at the mouth or site of wound, • rapid, weak pulse, • cyanosis, • falling blood pressure, • localized chest pain.
Open chest injuries Treatment
. Treatment 1. Seal the wound with any airtight material which will prevent air movement. E.g. use an extra barrier glove or part of a plastic bag. 2. Tape the material in place on three sides. Leave the bottom, based upon patient position, unsealed to release accumulated air between the lungs and the chest wall (lacking airtight material, use your gloved hand). More than one layer may be necessary to adequately seal the opening. 3. Continually monitor the dressing to ensure the seal is effective on inspiration only. Exhalation should allow air to escape on the bottom, unsealed edge.
Open chest injuries Transport the patient:
• in a position of comfort, • in a position that will not impair breathing, • administer oxygen, if available, • monitor vital signs, • activate EMS and treat as a load and go. Note: Transportation may be done with the head uphill if this is the position of comfort for a person with chest injuries or breathing difficulties for any reason.
Impaled objects
. Impaled objects are things such as broken glass or large splinters that are both embedded into and protruding from the body.
Impaled objects . Signs and symptoms
. Impaled objects are easily identified by sight.
Impaled objects Treatment
1. Do not move or remove the object, since major vessels or organs may have been penetrated. Bleeding into the chest cavity can be massive and may be difficult to detect. 2. Build up addressing around the object to hold it in place during transportation. 3. Tape the dressing in place. 4. Transport the patient in the most comfortable position possible, which may be either sitting or lying down. 5. Activate EMS and treat as a load and go. Continue to monitor vital signs. 6. If the object is obviously dangling from the skin or will cause extreme further damage, it should be removed.
Shock and Severe Bleeding
Shock is a condition of insufficient blood reaching body tissues. A technical definition is hypoperfusion of vital organs. Shock is caused by a disruption to the cardiovascular system and the body's failure to compensate and maintain blood pressure. Blood pressure is maintained by the heart pumping enough blood through a normal vascular system. Think of it as pumping plasma through pipes. If one of these is compromised, the other two compensate.
Signs and symptoms (Shock)
Increased pulse rate: Decreased pulse strength: Pale, cool, clammy skin; delayed capillary refill; cool extremities: Decreased level of consciousness: Increased respiration rate: Thirst: High anxiety, restlessness and aggression: General weakness, dizziness and nausea: Drop in blood pressure: NB. This is an extensive section and should be read.
Severe bleeding (hemorrhage)
The average adult body weighs 70 kg (154 lb.) and has about five litres of blood. Any injury that disrupts the blood supply is potentially dangerous: the more blood loss the greater the danger. An estimate of blood loss is important in assessing the seriousness of a bleeding injury.
Hemorrhage, if severe and left uncontrolled, leads to a series of deteriorating conditions…
• Hemoglobin loss reduces transportation of oxygen to the cells • Reduced blood volume lowers blood pressure • An increasing heart rate compensates for the lack of oxygen and lowered blood pressure • A decreasing heart rate results from a lack of oxygen and insufficient blood supply to the heart itself
Amount of Blood Loss and Result
Blood loss Result More than 20 per cent (about one litre) Moderate hypovolemic shock More than 30 per cent (about 1.5 litres) Severe hypovolemic shock - life threatening
Internal bleeding
Internal bleeding may result from a ruptured organ, such as a lung or spleen, or from a fracture. Signs and symptoms may or may not be evident in internal bleeding.
Internal bleeding Evident signs and symptoms
• If the patient coughs up bright red, frothy blood, then the source is the lungs. • If the patient vomits blood - often has the appearance of coffee grounds - then the source is the stomach. • If the patient excretes blood mixed with feces - often has a black, tarry appearance, then the source is the bowels. • If the patient has normal, red blood in the feces, then the source is the rectum. • If the patient has urine that is smoky or red in appearance, then the source is the kidneys and/or bladder. There may be pain over the kidney area as well.
Internal bleeding Non-evident signs and symptoms
. Internal bleeding resulting from a crushing type injury or from a blow to the abdominal region is very dangerous. The reason being the bleeding is not evident or easily identified. For example: • Bleeding into tissues associated with fractures may not be evident. • Bleeding from the liver, spleen or pancreas takes place into the abdominal cavity and does not appear outside the body. • The spleen may bleed into its capsule which may rupture at a later time, resulting in delayed symptoms.
Treatment for injuries to the extremities
• Check the limb for possible fractures. • Apply a cravat, or other form of bandage, to the wound. • Tie the knot directly over the wound to maintain constant pressure . • Elevate the injury. • Check distal circulation and sensation before and after bandaging. • Transport to medical aid. If PMS is compromised, activate EMS and treat as a Load and Go. • If bleeding is not controlled after 10 minutes, maintain direct pressure with fingers or hands during transportation. Activate EMS and transport to medical aid. When treating a bleeding injury, always remember the acronym, R E D: Rest - Elevation - Direct pressure
Internal bleeding at a fracture site
. Fractured large bones may bleed from the bone and marrow or from surrounding damaged tissues. Carefully examine the fracture site to determine if there is swelling. Even scarcely detectable swelling, associated with a fracture of the femur, may easily contain two litres of blood. Look carefully at all fracture sites and compare them with the opposite normal limb. If there is obvious swelling, assume there is loss of blood. Signs and symptoms of shock may be present as well as: • Pain, tenderness or discolouration where the injury is suspected. • Bleeding from mouth, nose, rectum or other natural body openings.
Head Injuries
External head injuries can range from relatively mild lacerations to life- threatening blockages of the airway and heavy bleeding. These injuries are relatively easy to recognize and treat. Differences from the standard protocol for major bleeds and fractures are noted in this chapter. Internal head injuries, such as concussions, can be less obvious yet are potentially more dangerous to the patient. If an internal head injury is suspected, the patient becomes a load and go, since the condition of the patient could deteriorate very quickly. Whenever external trauma to the head is present, always suspect an internal injury, as well as C-spine injury. A simple bump on the head becomes a load and go when the signs and symptoms of a fracture or concussion are present. NB. This is an extensive section and should be read.
Concussion
. trauma causes cerebral tissue to impact with the inside of the skull resulting in a temporary disruption of brain function; the effect is usually proportional to the magnitude of the blow. Although concussions are often associated with impacts with hard objects, they also occur when patients have been wearing helmets. Concussions are caused by the sudden deceleration of the skull followed shortly thereafter by the sudden deceleration of the brain that the cerebrospinal fluid cannot completely cushion. NB. This is an extensive section and should be read.
Concussion Look for the following…
Look for the following: Memory or orientation problems: • General confusion • Memory loss • Unaware of time, date, place • Repeatedly asks the same questions
Concussion Typical Symptoms
• Headache • Feeling dazed or "slow" • Dizziness • Seeing stars or flashing lights • Ringing in the ears (tinnitus) • Sleepiness • Loss of field of vision, double vision, blurred vision, light sensitivity • Nausea
Concussion Signs
• Poor coordination or balance. • Vacant stare or glassy-eyed. • Vomiting. • Slurred speech. • Slow to answer questions or follow directions. • Easily distracted, poor concentration. • Displaying unusual or inappropriate emotions (e.g. laughing, crying, swearing.) • Personality changes.
Subdural bleeding
Subdural bleeding usually results from trauma or tears in the veins below the dura. Symptoms of subdural bleeding have a slower onset than those of epidural bleeding because the lower pressure veins bleed more slowly than arteries. Thus, signs and symptoms may not show for several days or even weeks after an injury. When taking the history of a patient who has signs and symptoms of a head injury, ask about head injuries that may have taken place days or weeks before.
Subdural bleeding Signs and symptoms (Long)
Signs and symptoms may become apparent within a few minutes, a few hours, or they may not appear for two or three weeks or longer. They may include those of a concussion and any of the following: • Lowered level of consciousness including progressive or recurring loss of consciousness. • Bleeding or fluid from the nose, mouth or ears. • Convulsions, general or local. • Nausea. • Vomiting, especially by children. • Any unusual pupil reactions such as described in the secondary assessment or the table on page 10-8. • A bounding (high pressure) pulse and/ or a very slow pulse. • Cessation of breathing or patterned breathing. • Partial or complete paralysis of the limbs, abnormal weakness of the limbs especially on one side, or loss of sensation in any part of the body. • Discoloration behind the ears (Battle's sign). • Discoloration below the eyes (often known as raccoon eyes). • Abnormal or violent behavior. • Confused, disturbed speech pattern. • Headaches which may be severe. • Restlessness. • Fatigue.
Subdural bleeding Responsive Patient Treatment
Treat as a concussion. Determine the level of consciousness. If the patient is in full control of his or her faculties: • Maintain close and continuous monitoring. • The patient may appear normal, but close observation reveals slurred speech, slight disorientation, uncoordinated movements and weakness. • Carefully note these signs and look for signs of alcohol or drug abuse. • Smell the breath but never assume that apparent drunkenness is the result of alcohol.
Subdural bleeding UnResponsive Patient Treatment
Check: 1. respiration, 2. pulse, 3. responseofpupilstolight,and 4. responsetopainstimuli. If these signs are normal and stable, there is no immediate danger to airway or breathing. However, the situation may deteriorate. • Monitor the patient continuously. • Pay particular attention to the condition of the pupils. • The patient may vomit; this is especially prevalent with children. • Monitor and maintain the airway. • A patient with a head injury may recover consciousness and insist on leaving. This patient should be kept under medical supervision for 24 hours following the injury. Treat the development of any of the following as a load and go: • confusion, • deteriorating responsiveness, • abnormal pupil response, • vomiting, • weakness, • tiredness, • convulsions.
Cervical spine (C-spine) procedures
As soon as the need for C-spine procedures is recognized, a rescuer must stabilize the head until the patient is immobilized on a backboard. If you are first-on, suspend the rest of your assessment until others arrive. The only thing that takes priority over maintaining C-spine control is ABCs. Stabilize the head in a neutral position. A neutral position means: • eyes are forward, • nose, chin and sternum are in line, and • ears are in line with the shoulders. Gently conform your hands to each side of the head's contours. Your finger tips should not go beyond the jaw line. Try not to cover the patient's ears.
Apply a cervical collar
See the Manual Page 11-6 Do not remove the collar after it has been properly applied. Only qualified medical personnel should remove cervical collars. After application of the collar ensure it is not too tight. Ask the patient: When applied, the chin cup should rest snugly against the patient's chin with the lower edge of the collar resting against the sternum. If the collar you first try does not fit, change it to the proper size before securing it to the patient. • Can you breathe? • Can you speak? • Can you swallow? • If you have to re-adjust the collar, advise the patient that they will hear the Velcro strap tearing loose and that they should not be alarmed. Be aware that even a tightly fitted cervical collar does not completely immobilize the head and neck; it only reduces the extent of motion.
Tie down procedures using triangulars
See the Manual Page 11-6 Note that the head is secured to the backboard only after the thorax, the pelvic region and the legs are well secured to the backboard. Rescuer positioned at the patient's head will continue to stabilize the head Criss Cross Cravats: Chest (Be sure not two impair Breathing) Hips Knees Feet (figure of Eight) Broad Bandages Across: Chest (Be sure not two impair Breathing) Hips Knees (Above or Below) Tie a broad bandage so that it covers the eyebrows of the patient. Do not use a chin strap as it may prevent fluids from draining and prevent the patient from communicating. Tie one end of a triangular to the side of the brow bandage around the criss- cross of the chest bandages and then to the other side of the brow bandage. General Points: Use as many bandages or as much padding as required to prevent movement. Bandages applied with too much pressure may affect breathing or cause pressure on the spine. Try to prevent direct pressure on the knees.
Summary (LONG)
Conclusion Keep the following points in mind when dealing with spinal injuries: Support the patient's head in a neutral position. Make sure that the airway is kept clear. Apply a cervical collar to all patients with suspected spinal injuries. Do this as soon as possible once the patient is supine or sitting and the head is in a neutral position. If at any point, the patient displays signs of neurological deficits, the situations becomes a load and go. Have enough rescuers to move the patient safely. The number of rescuers required depends on the size and shape of the patient. Any movement must be slow and steady with continual monitoring of the patient. Avoid any motion which produces spinal flexion or rotation. If the patient's legs must be straightened: immobilize the body, and apply steady axial immobilization between the head and hips before moving the legs. To support the spine fully, place the patient on a backboard. A stretcher without the addition of a rigid support should only be used as a last resort. If possible, people injured in vehicles should be immobilized before they are removed. It is best to leave them in their vehicles until qualified help is available, unless priorities dictate otherwise. Place an unconscious patient so secretions can drain from the mouth by tilting the backboard sideways and supporting it with padding. Monitor a patient with a spinal injury continuously, and administer high flow oxygen if required.
Infection
Infection is the growth of foreign bacteria. Any break in the skin carries the risk of infection, especially if it is exposed to foreign agents. Contamination of the wound with dirt and soil introduces the risk of tetanus. The incidence of infection can be reduced with the application of an antibiotic cream or ointment (if no known allergies to the antibiotic) if the wound is an abrasion or superficial. Cover the wound with a sterile dressing and refer to medical care as appropriate.
The risk of infection varies with:
• the size of the injury, • the location of the injury, • the extent of external contamination, and • the time between the occurrence of the injury and reaching proper medical aid.
Infection Signs and Symptoms?
• Swelling. • Redness. • Tenderness. • Heat. • Pus which may indicate formation of an abscess.
Infection Treatment
• Leave the wound intact. • Cover with a sterile dressing. • Recommend the patient seek further medical aid.
General treatment of wounds
. There are several general principles regarding the treatment of wounds: • Prevent further complications. • Control bleeding. • Prevent infection.
General treatment of wounds Procedure (LONG)
• Examine for foreign material in the wound. • Remove any loose material and flush with saline or water (saline does not sting). If necessary, use a clean (sterile) gauze to gently remove debris while irrigating. Do not scrub vigorously, as this can cause more tissue damage. • If the wound is an abrasion or a superficial wound, check if the patient has any known allergies to the antibiotic. If the patient has no known allergy, apply an antibiotic cream or ointment to the wound. When administering antibiotic ointments or creams, use an intermediate device (e.g. cotton tips) between any multi- use container and the patient or administer using single-dose packages (preferred). • Place a sterile, non-adherent dressing over the entire wound. If this is not possible, use a clean, dry dressing, triangular bandage or some suitable cloth. Never use cotton batting as a dressing. • Apply direct pressure to any continuous bleeding. • Use a bandage or tape to hold the dressing in place. Use a pressure bandage where bleeding continues. • Always check for PMS distal to the wound before and after bandaging. • Elevate injury site. • Splint if necessary to keep the wound from moving and disrupting the clotting process. • Watch for signs of shock. • Monitor vital signs. • Recommend the patient seek further medical aid for any deep or significant wound.
Bone protrudes from the fracture site
1. Attempt to restore the bone ends under the skin by applying gentle traction. 2. Cover the bone with a dry, sterile dressing, avoiding pressure on the tip of the fractured bone. 3. Apply padding along either side of the injury. 4. Bandage the wound carefully. 5. Continue the splinting sequence. Remember no encircling bandages under the splint. You must be able to inspect the wound site without losing the integrity of the splint.
Basic principles of bandaging
A bandage • Should not be applied so tightly that it restricts circulation or so loosely that it allows a dressing to slip. It is important that a bandage be properly placed and well secured. • Must be tight enough to control hemorrhage or immobilize the wound without constricting circulation. • Must be applied so that pressure to the wound is evenly distributed. • Must cover the entire sterile dressing. Where possible, leave the fingers or toes of the bandaged extremity exposed enabling you to recheck distal pulses, motor response and sensation. Knots must be accessible. Place padding between the knots and the body. This will minimize possible pressure and sores. Never use encircling roller bandages underneath a splint; they may impair circulation.
Signs and symptoms that a bandage is too tight are:
• The skin distal to the bandage becomes pale or cyanotic (bluish). • The patient complains of pain usually only a few minutes after the bandage has been applied. • The skin distal to the bandage may be cold. • The skin distal to the bandage may be tingling and numb.
Triangular bandage for the open hand and foot (See Manual 13-11)
See Manual Page 13-11
Small arm sling (See Manual 13-16)
See Manual Page 13-16 Use the small arm sling for all upper arm injuries between the elbow and the shoulder in which the arm can be bent at the elbow. This sling permits gravity traction when required.
Categories of Fracture
Greenstick, Transverse, Oblique, Spiral, Comminuted, Impacted
Greenstick, Fracture
This is a soft bone fracture where the bone cracks or bends through the shaft, rather than breaking completely through. This is most commonly found in children.
Transverse, Fracture
This is a fracture that is perpendicular to the diaphysis (shaft) of the bone.
Oblique, Fracture
This is a fracture occurring at an angle to the diaphysis (shaft) of the bone.
Spiral, Fracture
This is a fracture in which the fracture lines spiral around the diaphysis (shaft) of the bone.
Comminuted, Fracture
This is a fracture consisting of more than two pieces.
Impacted, Fracture
This is a fracture where the broken ends have been driven into one another.
Extra-articular Fracture
This is a fracture that does not involve the joint surface.
Intra-articular Fracture
This is a fracture where the joint surface is affected, and can lead to long-term consequences of arthritis.
Purpose of splints
• protect the injured area, • give support and prevent further injury to the injured area, and • where possible, immobilize the joint above and below the fracture.
Other considerations
Splint material must be chosen according to the job it has to do. Choose from among the methods shown, taking into account the specifics of the injury, the location of the suspected fracture, and the equipment at hand. Splinting techniques vary from sport to sport, as the patient's clothing and footwear is very different. Always: • Check the pulse and colour distal to the injury before and after applying a splint to ensure that it has not restricted circulation. If distal pulse is absent after splinting, loosen the splint but do not remove it. If distal pulse is still absent, do not attempt to restore circulation by repositioning the injured limb. This may cause further damage. Activate EMS and treat as a load and go. • Check for motor response and sensation to ensure there is no interference of nerve function that has occurred during splinting.
Clavicle (collar bone)
. This common injury is produced by a fall on an outstretched hand or on the point of the shoulder. The collar bone acts as a spreader to brace the shoulder back.
Clavicle Fracture Signs and Symptoms
• The point of the shoulder rolls forward, inward and down. • Possible extreme pain. • Deformity. • Protruding bone. • The patient will usually support their forearm, across the front of their body, with their other hand.
Clavicle Fracture Treatment
The position of a clavicle fracture can be greatly improved by encouraging the patient to assume a position with shoulders back and chest out (not a slouched position). This optimizes the length of the clavicle and makes it less likely to tent the skin. The standard treatment is using a large arm sling and a transportation bandage. 2. Recheck the distal pulse and sensation. 3. Transport the patient in a position of comfort.
Treatment for open fractures
A protruding bone or deformity at a fracture site may block or damage blood vessels, restricting the flow of blood to the extremity. Infection may be introduced if the bone slips back into the wound. Doctors can treat infection more easily than they can correct disrupted circulation. If the bone was protruding, notify the doctor of that fact. In the case of an open fracture, the proper application of traction may return the bone to its normal position (within the wound). Apply a sterile dressing and bandage in the usual way. If the bone does not retract into the wound, apply a sterile dressing, then pad around the wound and secure with bandages.
Angina (angina pectoris)
Angina is pain resulting from a deficiency of blood supply - and therefore oxygen - to the heart muscle.If coronary artery disease is present, the narrowed arteries cannot provide the increased requirement for blood during strenuous physical activity or emotional distress. The heart muscle then becomes starved for oxygen, which may cause chest pain. This pain may vary from just a discomfort or tightness to very severe. The notable thing about angina is that the pain will usually ease or disappear if the patient rests. Generally, angina attacks will not last for more than 15 minutes after the stress stops. It is that fact which distinguishes an angina attack from a heart attack. Also, frequently the patient will have had previous episodes, and may be on medication.
Angina Signs and Symptoms
The signs and symptoms of an angina attack may vary from one person to another, but will normally be the same for any one person. If there is a change in this person's signs and symptoms, a heart attack should be suspected. • Sub-sternal pain, which may start suddenly or build up gradually. • Pain is usually described as moderate to heavy pressure or squeezing. • Pain may radiate across the chest, into the left or right arm, up into the neck or jaw, or into the back. • The attack may show up as a feeling of indigestion. • Pain usually lasts less than 15 minutes. • Pain is relieved almost immediately by medication. • Pain will not be influenced by changing the rate of respirations, coughing, or movement.
Angina Treatment
. 1. If the patient has medication, assist the patient in taking it. 2. Keep the patient at rest. 3. Give oxygen, if available. 4. Take a medical history. 5. Check for MedicAlert identification. 6. Evaluate vital signs. 7. Monitor vital signs during transportation. 8. If the patient does not improve with medication, or shows signs of getting worse, activate EMS and treat as a load and go. 9. Be prepared to treat the patient if they lose consciousness.
Angina Medication instructions
Angina patients use nitroglycerin. It comes in three different delivery options, patches, pills and a spray, Do not accidentally roll their patch and come in direct contact with the nitroglycerin. when assisting with the delivery of a spray type of medication, the nozzle needs to be pointed at the patient. The patient does not inhale the spray, but rather spurts it onto the underside of the tongue. Our standard practice of using gloves will ensure that you do not come into contact with the patients’ medications. . It is important to note that the patient should not administer more than three doses of either pills (placed directly under the tongue) or sprays (as directed) over a ten minute period. . Sprays are not to be administered if the patient has used erectile dysfunction pills such as Viagra, Levitra or Cialis within the last 24 hours.
Asthma See Chapter 16
See Chapter 16
Diabetes See Chapter 16
See Chapter 16
Epilepsy See Chapter 16
See Chapter 16
Heart attack See Chapter 16
See Chapter 16

Hyperventilation See Chapter 16
See Chapter 16
Unresponsiveness and lowered levels of consciousness See Chapter 16
See Chapter 16
Heat exposure injuries See Page 17-4
See Page 17-4
Heat transfer mechanisms Final response to heat loss Frostbite

When the temperature drops below a critical point, the core temperature falls rapidly. If this occurs, a patient is incapable of producing heat to re-warm the body. Heat must be supplied to the body, but this should normally be done only in a hospital setting.
Information on MSDS
Material safety data sheets 1. Product Information (product identifier (name), manufacturer and suppliers names, addresses, and emergency phone numbers) 2. Hazardous ingredients 3. Physical data 4. Fire or explosion hazard data 5. Reactivity data (information on the chemical instability of a product and the substances it may react with) 6. Toxicological properties (health effects) 7. Preventive measures First aid measures 8. Preparation information (who is responsible for preparation and date of preparation of MSDS)
General treatment for burns
1. Remove the cause. If the patient is on fire, douse the flames 2. Initiate basic life support if necessary. 3. Cool the burn using sterile water,if available, or use cool clean water. 4. Apply dry,sterile dressings to the burned area. If sterile dressings are not available, use several layers of cotton cloth. Dressings relieve pain by protecting the burn from the air. They also help in the prevention of infection. 5. Treat fors hock. 6. If the burn area was large requiring much cooling water, watch for hypothermia. 7. Transport to a medical aid facility. For extensive burns (more than 20 per cent of the body), do not use water, due to the danger of hypothermia. Wrap the patient in clean sheets and transport to a medical aid facility.
Burns: Immediate advanced medical aid is required if you encounter any of the following:
1. Burns to the face,inside the mouth, neck, hands, feet or genitals. 2. Any third-degree burns. 3. Second-degree burns that cover more than 10 per cent of the body. 4. Burns that occurred as a result of an explosion. 5. Second-or third-degree burns in children or the elderly.
Common hazards treating burns
1. Do not remove any charred clothing, metallic flakes or charred tissue from a burn. These materials have become imbedded (baked) into the skin and cannot be removed without causing more damage. 2. Do not apply absorbent cotton,wool,or other fibrous material directly to a burn. Strands of fibrous material tend to stick to the fluid being lost from a burn and increase the chances of infection. 3. Do not apply ointments to burned areas. Ointments form a barrier between the surface of skin of the burn and tend to hold in the heat. 4. Do not break blisters. Breaking the skin creates an open wound that allows body fluid to escape and increases the potential for infection.
Specific treatment for minor burns (Small and first-degree burns)
1. Immerse in clean, cold water for two to five minutes. 2. If unable to immerse the burn,use cold wet applications to relieve pain and decrease the depth of burn by reducing heat. 3. Cover with a sterile dressing. Early application of cold water is the best treatment.
Insect stings
Stings from insects such as bees, wasps, hornets, ticks and spiders are prevalent particularly during the warmer months and are more common among children. The body reacts to insect stings on two different levels, local and systemic.
Insect stings, Local response, Signs and symptoms
Most individuals stung by an insect have only a local reaction. • pain, • redness, • itching, • swelling in the form of a raised, firm welt, and • possible broken skin with bites.
Insect stings, Local Response, Treatment
1. If the sting was induced by a bee, carefully scrape the injection site in order to remove the stinger and its attached venom sac, if it is present. 2. Apply an ice pack to reduce inflammation and pain. Usually no further treatment is necessary.
Insect stings, Systemic Response
In approximately five per cent of the population, a generalized systemic reaction occurs with insect stings, particularly bee stings. The patient in these cases displays an acute allergic reaction to the venom, known as anaphylaxis. In anaphylaxis, death can occur within as little as five minutes from the time of the sting. These people may have their medication with them and may require assistance.
Insect stings, Systemic Response Signs and Symptoms
• difficulty breathing, • swelling (particularly about the throat, tongue, eyes and nasal passages), • skin welts, or hives, • generalized itching, • weakness, • headache, • abdominal pain, • anxiety, and • restlessness.
Insect stings, Systemic Response Treatment
1. Provide life support as indicated by checking and monitoring vital signs and assist the patient with taking their own medication if necessary. 2. If the sting occurred on an extremity, place a constriction bandage above the site 3. If the stinger with its venom sac is present and visible, carefully scrape it from the skin. If it is a tick bite, grasp the tick with tweezers as close to the skin as possible. The tweezers should be held at a right angle to the main axis of the tick's body. Gently pull the tick away from the host's skin. Avoid twisting or turning the tick during removal. Examine the tick to ensure that it has been completely removed. 4. Apply an ice pack to the area to reduce pain and local blood flow. 5. If possible, collect and transport any insect that may be the source of the bite for identification purposes. 6. If possible,cleanse the area with saline solution or soap and water. Apply dressing if necessary. 7. Transport the patient without delay to a medical facility.
Jellyfish stings
To inactivate venom from a jellyfish sting and prevent further venom being injected, the site of the sting should be liberally washed with vinegar (4% to 6% acetic acid solution) as soon as possible and for at least 30 seconds. After the nematocysts are removed or deactivated, the pain from jellyfish stings should be treated with hotwater immersion when possible. The water should be as hot as can be tolerated for an immersion of approximately 20 minutes.
Ear and nose problems
There is little that first aid can do in practice for internal injuries to the ear or nose.
Ear and nose problems, Earache
Refer the patient to medical aid.
Ear and nose problems, Foreign body
Refer the patient to medical aid if they have a foreign body in their ear or nose. If a foreign body is present, warn them not to blow their nose.
Childbirth See Chapter 19
See page 19-7
Critical incident stress; Definition
a normal response, experienced by normal people to an abnormal event.
Critical incident stress; Causes
• death or serious injury of a person, • suicide or unexpected death, • multiple-patient incident, • death of a child (particularly if due to violence), • serious injury or death of the patient or bystander during a rescue, • situations when there is personal identification with the patient or the circumstances, • any incident that attracts media attention, or • when the signs, sounds and/or smell of the incident are so distressing as to produce a high level of immediate or delayed emotional reaction.
Critical incident stress; Signs and Symptoms (LONG)
critical incident stress may be felt at the scene or after the incident is over. CIS can manifest itself either physically, emotionally or in the individual's logical thinking process. They include: • physical conditions such as: • sudden fatigue, • nausea or vomiting, • shock-like symptoms, • twitching or tremors. • thinking process conditions such as: • memory loss, • inability to clearly identify things by their proper terms, • confusion, • impaired thinking, or • reduced attention span. After the incident, you may experience irritability, frustration, difficulty in concentrating, sleeplessness, or flashbacks associated with the incident itself or any personally appalling aspect of the incident, displays of anger and frustration, sadness, or distancing yourself from family and friends. You may become extremely self-critical of personal skills and question the ability to provide help to someone else in the future. All of these feelings are normal following a critical incident and will eventually pass with time.
Critical incident stress; Treatment
. Treatment The effects of CIS can be greatly reduced by simply talking to another trusted patroller about the incident and the feelings it generated. . Talking with the other patrollers who were a part of the incident is even more powerful. The sooner the incident is discussed, the better. A good time to discuss the day's events is prior to leaving the hill, at the end of the day. It is an opportunity to put the incident in perspective.
Anatomy and physiology of the pediatric patient
A child's body grows and develops into their adult form by approximately eight years of age. The tongue is proportionately larger than an adult in comparison to the size of the mouth. The tongue is the most common cause of airway obstruction, especially when the neonate is supine. NB. This is an extensive section and should be read.
Three-handed seat
Use the three-hand seat so one hand is free to support an injured leg or the patient's back. NB. This is an extensive section and should be read.
Loading the patient into the toboggan See Page 21-5
See Page 21-5

Transfer patient on a backboard from a toboggan to a bed
1. If the patient is on a backboard, ensure the patient is firmly tied down. 2. With one patroller at the head end and a second at the foot end of the backboard, lift the backboard, maintaining a straight back. 3. Move sideways to the bed and move the backboard onto the bed. 4. If the patient is heavy, use two more patrollers to help.