- Check the Scene- Is it safe for me to help? What happened? How many patients are there? Am i going to need assistance from EMS? Do I have my personal protective equipment ready to use?
- Check the Patient- Tap and shout. Is there any response? Look at the person's chest and face. Is the patient breathing normally? Agonal respiration are not normal breathing. They would be characterized as occasional gasps.
- Activate EMS- Call 911- Send someone to call and tell them to come back. The caller should give dispatch the patient's location, what happened, how many people are injured, and what is being done. If alone and no one is available PHONE FIRST for adults and get the AED. Returns to start CPR and use the AED for all ages. CARE FIRST for children and infants by providing about 5 cycle or 2 minutes of CPR before activating the emergency response number. CARE FIRST for all age patients of hypoxic arrest.
- Compressions- If the victim is unconscious with no normal breathing and is not moving, begin chest compressions. Give 30 compressions at a rate of a least 100 per minute for all ages.
- Hand Placements-
Adult- Place heel of hand of the dominant hand on the center of the chest between the nipples. The second hand should be placed on top. Compress at least 2 inches deep.
Child- Place heel of one hand in the center of the chest between the nipples. Use the second hand if necessary. Compress at least 1/3 the depth of the chest.
Infant- Place two fingers on the center of the chest between the nipples. Compress at least 1/3 the depth of the chest.
Airway- Open Airway using head tilt chin lift, look in the mouth to make sure the airway is clear. If you see any foreign object, sweep it out right away.
Breathing- Give 2 breaths lasting 1 second each. If not using mask, make sure you make a seal over the mouth on an adult or child and pinch the nose closed each time you give a breath. On an infant, make sure to cover the mouth and nose with your mouth. Continue 30 compressions to 2 breaths until an AED arrives, advanced medical personnel take over, patient shows sign of life, the scene becomes unsafe, or you are to exhausted.
- Ask," Are you choking? If a person is unable to breath or speak, treat the patient.
- Treatment- Activate EMS
Adult/Child- Stand behind the victim with one foot in-between the victims feet and your other foot behind you. Place the flat side of your fist just above the patients belly button. Grab the back of your fist with your other hand. Administer abdominal thrusts, pulling inward and upward, until the object comes out or the patient becomes unconscious.
Infant- Support the infant's face and place body on your forearm Keep the infants head lower than the feet. Administer 5 back blows between the shoulder blades with the palm of you hand. Support the infant's head. Turn the baby over onto your other forearm. Give 5 chest thrusts. Continue back blows and chest thrusts until object comes out or infant becomes unconscious.
Special Circumstances- If the patient is pregnant or too large to reach around, give chest thrust instead.
- If you're giving someone abdominal thrusts and the person goes unconscious, lower the patient safely to the ground. Activate EMS, send someone to call 911
- Adult/Child/Infant- Give 30 chest compressions
- Open airway and check the mouth for a foreign body. If something is seen sweep it out with a finger. Use the pinky finger for an infant.
- Attempt rescue breaths. If breaths do not make the chest rise, repostition head and reattempt rescue breaths.
- Adult/Child/Infant- Give 30 compressions
- Open the airway and check the month for a foreign body. If something is seen sweep it out with a finger. Use the pinky finger for an infant.
- Give 2 breaths. If breaths do not make the chest rise, reposition head and reattempt rescue breaths. Continue compressions, foreign body check, breathing attempts until air goes in and chest rises.
- If victim is still unconscious and not breathing normally, continue CPR with cycles 30 compressions to 2 breaths.
- If the victim vomits, roll the victim on his side and clear out his airway. After the airway is cleared. Roll the victim back and continue care.
AED- Auto External Defibrillator
- AED's are designed to shock the heart, in order for the heart to restart under a normal rhythm. The AED analyzes the hearts an rhythm, states whether a shock is advised and then powers up, the operator then pushes a button that will deliver the shock.
- Each minute that defibrillator is delayed the chance of survival is reduced by 10 percent. After 10 minutes few people are resuscitated
- Early defibrillator increases survival rates to greater than 50%
- Rescuers should begin chest compressions as soon as possible, and use the AED as soon as it is available and ready
- If you are giving CPR to a child or infant and the available AED. does not have child pads or a way to deliver a smaller dose, it is still recommended to use the AED even with adult pads
- Remove a patient from standing water, such as in a puddle, before AED use. Rain, snow, or a damp surface is not a concern.
- Patient should be removed from a metal surface if possible.
- Slightly adjust pad placement so as not to directly cover the area if the patient has an obvious bump or scar for a pacemaker.
- Remove medication patches found on the patient's chest with a gloved hand.
- Never remove the pads from the patient or turn the machine off.
Steps of an AED
- Turn the machine on
- Bare the chest. Dry it off if it is wet. If there is excessive hair you may need to shave it off
- Place one pad on the patients upper right chest above the nipple. Place the other pad on the patients lower left ribs below the armpit
- Make sure pads are pressed down firmly
- Follow AED prompts
- Stand Clear. Do not touch the patient while the AED analyzes
- If the AED says,"Shock advised, charging..;.." shout, "Clear" and make sure no one is touching the patient. Push the shock button when the AED tells you to.
- If no shock is advised give CPR if the patient. Push the shock button when the AED tells you to.
- If no shock is advised give CPR if the patient is not moving and not breathing
- As soon as the shock has been delivered, give 30 chest compressions followed by 2 breaths. Continue cycles of 30:2 until you see signs of life
- The AED will reanalyze every 2 minutes and prompt for a shock if needed
Child/Infant Pad Placement
- For children ages 1-8 and AED with child pads and a dose attenuator should be used.
- For Infants 1 year of age, it is preferable to use a manual defibrillator. An AED with child pads and a dose attenuator can be used for infants
- If only a standard AED with adult pads is available, it should still be used for children and infants in cardiac arrest.
- Child pads are normally smaller than adult pads. For children, the pads should be placed in the normal anterior-lateral position. When placing the pads on a child, the pads should not touch
- For a small child or infant, the pads should be place in the anterior posterior position
- Check the person- Ask," I'm trained in first aid, can i help you?"
- Call 9-1-1- send someone to call 911
- Direct Pressure- Apply gloves. Use gauze or other barrier to apply direct pressure to site of wound. Evaluate if no fracture is suspected
- Pressure Bandage- Apply more dressings if needed and a pressure bandage
- Recheck- Check for capillary refill, skin color, and skin temperature to make sure the bandage is not too tight. Loosen if necessary