First-Aid Training

Written by: EMS Lieutenant Nikolay R. F-107

Approved by: San Andreas Fire Rescue’s Chain of Command

Approved on: September 16th, 2019.

Table of Contents

1. Introduction.
2. Materials for First Aid Care.
3. Patient Assessment.
4. Cardiopulmonary Resuscitation (CPR).
5. First Aid Care for Unconsciousness.
6. First Aid Care for Non-Breathing and/or Pulseless patient.
7. Bleeding Control and Shock Management.
8. First Aid Care for Impaled Object/s.
9. First Aid Care for Burns and Scalds.
10. First Aid Care for Dislocations/Fractures.
11. First Aid Care for Choking.
12. First Aid Care for Heart Attack/Stroke.
13. First Aid Care for Narcotics/Opioids Overdose.
14. First Aid Care for Seizures.
15. First Aid Care for Allergic Reactions.
16. Infection Prevention.

1. Introduction.

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1.1 What is First Aid Care?

First Aid is the first and immediate assistance given to any person suffering from either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening or to promote recovery.

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1.2 What is the purpose of this course?

This course is designed for personnel with no SAFR BLS/ALS training, who would like to learn basic life support saving skills. This course IS NOT a substitute for EMS response, but rather, a course to teach you the skills to keep a patient alive until the arrival of EMS.

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2. Materials for First Aid Care.

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2.1 - M-9 Assault Medical Backpack

The M-9 Assault Medical Backpack is a small and compact backpack that can fit in the trunk of every Law Enforcement Vehicle. It’s filled with basic First Aid Care supplies.

Field Ready Contents:

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• Headlamp with Multi-Color Lighting.
• Tactical Rescue Knife.
• Z-fold Combat Gauze Packs.
• SOFTT-W Tourniquets.
• Hyphen Chest Seal.
• Compression Bandages.
• Emergency Bandage, 4”.
• Compressed Gauze Packs.
• Burn Dressing, 18”x 18” (Sterile).
• Nasopharyngeal Airways.
• Lubricant Foil Packs.
• Oral Airways, (80mm & 100mm).
• Pocket Bag Valve Mask.
• Disposable Suction Device.
• Elastic Bandages, 5”x 5yds.
• SAM Splints, 36”.
• Gauze Pads, 4”x 4” and 2”x 2” (Sterile).
• Adhesive Tape, 1”x 10yds.

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• Triangular Bandages, 40”x 40”.
• Trauma Shears.
• Straight Kelly Hemostat, 6.25”.
• Mosquito Hemostats, 3.5”.
• Fine Point Forceps, 4.5”.
• Adhesive Bandages, ⅞”x 3”.
• Fingertip Adhesive Bandages.
• Knuckle Adhesive Bandages.
• Alcohol Prep Pads.
• Iodine Prep Pads.
• Nitrile Gloves.
• Permanent felt-tip marker, Blue.
• TacNotes, 4’x6”.
• 4mg Naloxone Nasal Spray.
• Israeli bandages.
• Cervical Collar.
• 3x Epinephrine 1:1000 pens (.3 mg each).

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Medical Bag Overview

2.2 - Automated External Defibrillators

The Automated External Defibrillators also known as AEDs are automated defibrillators that scan for shockable rhythm on their own and shock the patient on their own.

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This on the right is a Lifepak CR2 Semi-Automatic AED, which servers for both Pediatric and Adults.

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Step by step AED usage for Pediatric:

1. Place the first AED pad (left) between the T2 and T7 Thoracic Spinal Nerves.
2. Place the second AED pad (right) in the middle of the Sternum.
3. Turn on Child Mode and analyze for shockable rhythm.
4. If shockable - press the Shock button.
5. If not shockable - continue CPR until EMS arrives.

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Step by step AED usage for Adults:

1. Place the first AED pad (left) on the right side of the chest, just below the collarbone.
2. Place the second AED pad (right) on the lower left side of chest.
3. Analyze for shockable rhythm.
4. If shockable - press the Shock button.
5. If not shockable - continue CPR until EMS arrives.

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3. Patient Assessment.

3.1 ABCDE

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A - Airway.

B - Breathing.

C - Circulation.

D - Disability.

E - Exposure.

3.1.1 Airway

- The passage by which air reaches a person’s lungs.

The easiest way to open the airway and check for any obstructions is by performing

a head tilt and chin lift technique as showed below.

3.1.2 Breathing

Breathing is the process of moving air into and out of the lungs to facilitate gas exchange with the internal environment, mostly by bringing in oxygen and flushing out carbon dioxide.

The easiest way to check for adequate air exchange is by looking, listening and feeling.

3.1.3 Circulation

Pulse is the rhythmic dilation of an artery that results from the beating of the heart. Pulse is often

measured by feeling the arteries of the wrist or neck. In order to acknowledge one’s pulse,

the treating party should locate the first available artery and position your index and middle

finger over it in order to feel for a beat.

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Blood Circulation is one of the most important functions in the body. It supplies oxygen to the

brain and other organs. It’s what makes our bodies work. The easiest way to acknowledge one’s

blood circulation is by squeezing the nail of a toe or finger, it will turn white due to the applied

pressure, release the pressure and time how long it takes for the pink color to return. The faster,

the better.

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3.1.4 Disability

The easiest way to check for disabilities is to establish contact with the patient, perform a sternum rub, speak to them and check for responsiveness.

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a more advanced way to check for disabilities is to perform the Glasgow Coma Scale.

3.1.5 Exposure

Signs of trauma, bleeding, skin reactions, needle marks, etc, must be observed. Bearing the dignity of the patient in mind, clothing should be removed to allow for a thorough physical assessment. Body temperature can be estimated by feeling the skin or using a thermometer, if available.

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4. Cardiopulmonary Resuscitation (CPR).

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4.1 CPR

Cardiopulmonary Resuscitation is to be conducted only if - Patient has no pulse, Water inside their lungs or very poor blood circulation.

Prior to beginning CPR you should complete a few simple steps. - Complete ABCDE Assessment, Complete Trauma Care. CPR does not work if the Patient has a chance of bleeding out, only perform CPR when the bleeding is controlled.

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4.2 How to use a Defibrillator

Defibrillators can be used on children, teens and adults over 1 year of age. AEDs are used

to treat sudden cardiac arrest.

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Prior to using an AED, complete a full ABCDE Patient Assessment, treat all injuries and

attempt at least 1 round of CPR.

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Step by step guide for the usage of an AED:

1. Complete a full ABCDE Patient Assessment.
2. Expose the Patient’s upper body.
3. Follow AED protocols from Section 2.2.
4. Analyze for shockable rhythm.
5. Shock if shock is advised.
6. Continue CPR is shock is NOT advised.

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5. FAC for unconsciousness.

5.1 FAC for unconsciousness

First Aid Care for an unconscious patient is simple, following a few steps.

1. Conduct a full ABCDE Patient Assessment.
2. Call Emergency Medical Services.

If the patient is respirating properly, put them into recovery position. If they are not - begin CPR.

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Step by step in order to put a patient into recovery position:

1. Kneel next to the person. Place the arm closest to you straight out from the body.
2. Position the far arm against their cheek.
3. Take hold of the knee furthest from you and pull it towards you until the knee is on the floor, positioned at a right angle.
4. Make sure that the airway remains open by tilting the head back and lifting the chin.
5. Monitor the patient’s condition until EMS arrives.

6. FAC for Non-Breathing and/or Pulseless Patient.

6.1 FAC for Non-Breathing Patient

First Aid Care for a Non-Breathing Patient with a pulse is fairly simple.

• Conduct a full ABCDE Patient Assessment.
• Call Emergency Medical Services.
• Begin Rescue Breathing.

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Step by step for rescue breathing.

• Grab a BVM.
• Tilt the head back, lift the chin.
• Perform an E-C technique to establish a face mask seal over the patient’s face.
• Start delivering 1 rescue breath over a second, every 5-6 seconds, for 2 minutes.

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6.2 FAC for Non-Breathing and Pulseless Patient

First Aid Care for a Non-Breathing and Pulseless Patient is fairly complicated.

• Conduct a full ABCDE Patient Assessment.
• Call Emergency Medical Services.
• Begin CPR.

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Step by step for CPR:

• Grab a BVM, Tilt the head back, lift the chin.
• Perform an E-C technique to establish a face mask seal over the patient’s face.
• Follow the steps from Section 4.1 and 4.2.

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7. Bleeding Control and Shock Management.

7.1 Bleeding Control

Bleeding control may be necessary for many reasons. This may include stab wounds, gunshot wounds and other types of lacerations to the body. When taking control of bleeding make sure to put direct pressure to the wound with your gauze and use a tourniquet if needed (on limbs). Keep in mind that wounds around the chest or the neck may need to be closed to make sure air does NOT get into the chest cavity.

Step by step FAC for Bleeding Control on the limbs.

1. Apply a tourniquet above the bleeding site.
2. Pack the wound with a hemostatic bandage and or long rolls of gauze. Apply pressure when not actively packing.
3. Wrap wound in Israeli bandage or gauze if bandage can not fit.

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Step by step FAC for Bleeding Control on the chest/neck.

• Apply direct pressure to the wound.
• Pack the wound with long rolls of gauze.
• Remove the gauze and apply a hyphen chest seal if the wound is on the chest (if a GSW).
• Continue applying pressure.

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7.2 Shock Management

Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do not get enough oxygen and nutrients to function properly. Many organs can be damaged as a result.

Step by step FAC for Shock Management.

• Lay the patient down.
• Lift the patient’s knees up.
• Open the airways.
• Cover the patient with a blanket.

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8. FAC for Impaled Object/s.

8.1 FAC for Impaled Object/s

When you have a patient with an object impaled in them, the last thing to do is to remove the object. From the outside it may seem like a piece of glass stuck in someone’s leg, but in reality this piece of glass may be stopping a ruptured blood vessel from bleeding.

Step by step FAC for an Impaled Object/s.

• Apply 2 rolls of gauze on both sides of the impaled object (you can stack them up to the height of the object).
• Start rolling layers of gauze around and over the rolls of gauze.

For better explanation please watch the video below.

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9. FAC for Burns and Scalds.

9.1 FAC for Burns and Scalds

There are five signs which may be seen when someone has a burn or scald.

• Red Skin.
• Swelling.
• Blisters on the Skin.
• Peeling Skin.
• White/Scorched Skin.

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Step by FAC step for Burns/Scalds:

• Move them away from the heat source.
• Start cooling the burn - place it under cool running water for at least 10 minutes (if available).
• Apply Burn Dressing.
• Cover the burn dressing with gauze or bandages.

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10. FAC for Dislocations/Fractures.

10.1 FAC for Dislocations/Fractures

There are a few signs signs which may be seen when someone has a dislocation or a fracture.

• Swelling or bruising.
• Deformity of the limb.
• Loss of function in the injured area.

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Step by step FAC for Dislocations/Fractures:

• Locate the dislocation/fracture.
• Apply a SAM splint (refer to the videos on the right).

If there is a Cervical-Spinal injury - apply a cervical collar.

If there is a Spinal Injury - restrain the patient from moving as much as possible.

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11. FAC for Choking.

11.1 FAC for Choking

The danger signs of choking are:

• Bluish skin color.
• Difficulty breathing.
• Loss of consciousness.
• Inability to cry or make much sound.
• Weak, ineffective coughing.
• Soft or high-pitched sounds while inhaling.

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Step by step FAC for Choking:

• Confirm that the patient is Choking.

Begin Heimlich:

1. Stand behind the patient, wrap your arms around them.
2. Form a fist over the patient’s belly button.
3. Begin thrusting.

If the patient is pregnant, form the fist over the patient’s breastbone.

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12. FAC for Heart Attack/Stroke.

12.1 FAC for Heart Attack

Prominent signs of a heart attack are:

• Breathlessness and anxiety.
• Chest pain.
• Sweating and palpitations.
• Nausea.

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Step by step FAC for Heart Attack:

• Sit the patient on the floor in an upright position.
• Lift patient’s knees up.
• Support the patient and assure them that everything is going to be alright till EMS arrives.
• If the patient has no pulse begin CPR.

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12.2 FAC for Stroke

Prominent signs of a stroke are:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing or blurred vision in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or coordination.
• Face dripping on one side of the face.

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Step by step FAC for Stroke.

• Keep them comfortable and reassure them.
• Do not give them anything to eat or drink, because it may be hard for them to swallow.
• Keep monitoring their level of response.
• If they become unresponsive, follow steps from Section 5.1.

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13. FAC for Narcotics/Opioids Overdose.

13.1 FAC for Narcotics/Opioids Overdose

Prominent signs of an Overdose are:

• Blue lips or nails.
• Dizziness and confusion.
• Can’t be woken up/unconsciousness.
• Choking, gurgling or snoring sounds.
• Slow, weak or no breathing.
• Drowsiness or difficulty to stay awake.
• Seizures/Foam dispensing out of mouth.

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Step by step FAC for an Overdose.

• Administer 4mg of Naloxone intranasally - 2mg in left nostril, 2 mg in right nostril.
• Begin Oxygen Administration.
• Follow instructions from section 5.1.

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14. FAC for Seizures.

14.1 Signs of a Seizure

There are 2 different types of seizures and these are their signs:

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Type 1:

Tonic Phase:

• All the muscles stiffen.
• Air being forced past the vocal cords causes a cry or groan.
• The person loses consciousness.

Clonic Phase:

1. The arms and usually the legs begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips and knees.
2. After a few minutes, the jerking slows and stops.

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Type 2 (Focal Seizure).

1. Muscle contractions.
2. Odd sensations.
3. Abnormal head or eye movements.
4. Automatisms or repetitive movements, such as skin-picking or lip-smacking.
5. Vision changes.

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14.2 FAC for a Seizure

Step by step FAC for a Seizure:

• Clear away any potential dangerous objects.
• Protect their head by placing something soft underneath or around it.
• Once the seizures have stopped - open their airway and check their breathing, if they are breathing - put them into the recovery position.

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IMPORTANT NOTES:

1. Do not attempt to immobilize the patient during the seizure!
2. Do not attempt to restrain the patient during the seizure!
3. There might be a secondary or more seizures after the first one!

15. FAC for Allergic Reactions.

15.1 FAC Allergic Reactions

Prominent signs of an Allergic Reaction are:

• Hives.
• Itching.
• Difficulty Breathing.
• Swelling of the face, eyes or tongue.
• Flushing of the face.
• Swollen lips, tongue or throat.
• Tightness in the throat or a feeling that the airways are closing.

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Step by step FAC for an Allergic Reactions.

• Administer 1x EPI Pen (.3mg) Intramuscularly. (Repeat every 5 minutes to a total of 3 doses).

If patient is unconscious:

1. Administer EPI.
2. Lift the head back, tilt the chin up, start providing Oxygen via BVM.

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16. Infection Prevention.

16.1 Infection Prevention

How infections are passed on:

• Blood and body fluids - Saliva, sneezing, vomit, pus from infected sores, urine, vaginal and seminal fluids.
• Hypodermic Needles - Sharing a needle, teaspoon, or being stabbed by an infected needle.
• Blood transfusions with infected blood or plasma.

DURING FIRST AID TREATMENT:

• Wear nitrile gloves.
• Wear safety glasses.
• Do not cough or sneeze onto the patient’s wounds.
• Use clean bandages and dressing.
• Clean wounds and try not to get dirt into them.

AFTER FIRST AID TREATMENT:

• Dispose of gloves and used equipment properly.
• Wash and disinfect hands thoroughly.
• Wash blood off any clothes or surfaces with bleach.

Procedure for Needle Stick Injuries:

• Wash the injury immediately.
• Promote bleeding.
• Apply antiseptic solution to injury.
• Dress the wound.
• Try not to panic, the calmet you are - the slower your heart will beat.
• GO TO THE HOSPITAL IMMEDIATELY!

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Any questions?

Contact any of the following people:

San Andreas Fire Rescue - Department Leaders:

Fire Chief - Colin L. F-100.

Assistant Fire Chief - Nikolay R. F-101.

Battalion Chief - Cameron L. F-102.

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San Andreas Fire Rescue - EMS Command:

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EMS Captain - Mike L. F-104.

EMS Lieutenant - Jason A. F-107.

Written by:

Nikolay R. F-107

Approved by:

SAFR CoC