Facility Safety Management

arms above the head and rolling the body to the side so that the victim’s head rests on the extended arm. Bend both legs to stabilize the victim.

Medical Emergencies

Breathing Difﬁculties: The incidence of acute asthma is increasing, especially in urban populations. Many victims with asthma have and can self-administer bronchodilator medication. Inhaled bronchodilator medications are safe with few untoward effects.

First aid providers may assist the victim in using prescribed bronchodilator medication. They are not expected to make a diagnosis, but they can assist the victim under the following conditions:

. • The victim states that he or she is having an asthma attack and has medications or an inhaler; and

. • The victim identiﬁes the medication and is unable to administer it without assistance.

Anaphylaxis: Allergies are relatively common, but only a small proportion of people with allergies develop anaphylactic reactions. An anaphylactic reaction is characterized by swelling, especially of the face, breathing difﬁculty, shock, and even death. Many people with a history of anaphylaxis carry a lifesaving epinephrine auto-injector. With proper training, parents can be taught to correctly use the auto-injector to administer epinephrine to their child. Unfortunately all too often neither the victim nor family members know how to use an auto-injector correctly.

First aid providers should be familiar with the epinephrine auto-injector so that they can help someone having an anaphylactic reaction self-administer the epinephrine. First aid providers should be able to administer the auto-injector if the victim is unable to do so, provided that the medication has been prescribed by a physician and state law permits.

Seizures: The general principles of ﬁrst aid management of seizures are to (1) prevent injury, (2) ensure an open airway, and

(3) ensure that the airway remains open afterthe seizure has ended.

The victim of a seizure must be protected from injury. Protect the head with a pillow or other soft material. Do not restrain the victim during a seizure or place any object in the victim’s mouth. Restraining the victim may cause musculoskeletal or soft-tis-sue injury. Placing an object in the victim’s mouth is futile because most tongue biting occurs at the onset of seizure activity and attempts to insert an object may cause dental damage or aspiration or may injure the rescuer’s ﬁngers.

To prevent aspiration of secretions and maintain an open airway, place the victim in a recovery position after the seizure stops. It is not unusual for the victim to be unresponsive or confused for a short time after a seizure.

Bleeding: Control of bleeding is one of the few actions by which you can critically inﬂuence outcome. Control external bleeding by applying pressure over the bleeding area until bleeding stops or EMS rescuers arrive.

The important factors in successful control of bleeding are to apply pressure ﬁrmly and for a long time. Methods of applying pressure include:

• Manual pressure on gauze or other cloth placed over the bleeding source. If bleeding continues, do not remove the gauze; add more gauze on top and apply more pressure; and
• An elastic bandage ﬁrmly wrapped over gauze to hold it in place with pressure.

The effectiveness, feasibility and safety of tourniquets to control bleeding by ﬁrst aid providers are unknown, but the use of tourniquets is potentially dangerous. Tourniquets are routinely used in the operating room under controlled conditions and have been effective in controlling bleeding from an extremity, but potential undesired effects include temporary or permanent injury to the underlying nerves and muscles, as well as systemic complications resulting from limb ischemia, including acidemia, hyperkalemia, arrhythmias, shock, limb loss and death.

Complications are related to tourniquet pressure and occlusion time. Pressure has been found to be superior to tourniquets in controlling bleeding, although tourniquets may be useful under some unique conditions (e.g., the battleﬁeld, when rapid evacuation is required and ischemic time is carefully monitored). The method of application and the best design of tourniquets are under investigation.

Also, there is insufﬁcient evidence to recommend for or against the ﬁrst aid use of pressure points or extremity elevation to control hemorrhage. The efﬁcacy, feasibility, and safety of pressure points to control bleeding have never been subjected to study, and there have been no published studies to determine if elevation of a bleeding extremity helps in bleeding control or causes harm. Using these unproven procedures has the potential to compromise the proven intervention of direct pressure.

Wounds and Abrasions

Irrigate wounds and abrasions with clean running tap water for ﬁve minutes or until there appears to be no foreign matter in the wound. If running water is unavailable, use any source of clean water. Wounds heal better and with less infection if an antibiotic ointment or cream is used, and triple antibiotic ointment appears to be superior to single antibiotic ointment or cream. Apply antibiotic ointment or cream only if the victim’s wound is an abrasion or is superﬁcial.

Burns

Thermal Burns: Cool thermal burns with cold water as soon as possible and continue at least until pain is relieved. Cooling reduces the injury and relieves pain. There is some evidence that brief cooling of small burns with ice water may be effective, but direct application of ice to a burn may produce tissue ischemia, and prolonged cold exposure even of small burns can lead to further injury. Avoid cooling of burns with ice or ice water for longer than 10 minutes, especially if the burn is large.

Burn Blisters: Loosely cover burn blisters with a sterile dressing but leave them intact.

Electrocution and Electrical Burns: The severity of electrical injuries can vary widely, from an unpleasant tingling sensation caused by low-intensity current to thermal burns, cardiopulmonary arrest, and death. Thermal burns may result from burning clothing that is in contact with the skin or from electric current traversing a portion of the body. When current transverses the body, thermal burns may be present at the points where the current entered and exited the body and internally along its pathway.

Cardiopulmonary arrest is the primary cause of immediate death from electrocution.

Do not place yourself in danger by touching an electrocuted victim while the power is on. Turn off the power at its source; at home the switch is usually near the fuse box. In case of high-volt-age electrocution, such as that caused by fallen power lines, immediately notify the appropriate authorities.

All materials will conduct electricity if the voltage is high enough, so do not enter the area around the victim or try to remove wires or other materials with any object, including wooden ones, until the power has been turned off by knowledgeable personnel. Once the power is off, assess the victim, who may need CPR, deﬁbrillation, and treatment for shock and thermal burns. All victims of electric shock require medical assessment because the extent of injury may not be apparent.

Spine Stabilization

There is an approximately 2 percent risk of injury to the cervical spine after blunt trauma that is serious enough to require spinal imaging in an emergency department, and this risk is tripled in patients with craniofacial injury. Most victims with spinal injuries are males between the ages of 10 and 30 years.

Motor vehicles cause approximately half of the injuries; the remainder are caused by falls (especially from a height or diving), sports and assaults.

A victim with a spinal injury has an increased risk of permanent neurologic damage, including quadriplegia from a secondary spinal cord injury. First aid rescuers may not be able to conclusively identify a victim with a spinal injury, but they should suspect spinal injury in a victim of blunt trauma.

Soft Tissue Injuries

Soft-tissue injuries include joint sprains and muscle contusions.

Apply cold to soft-tissue injuries. Cold application decreases hemorrhage, edema, pain, and disability. Cooling is best accomplished with a plastic bag or damp cloth ﬁlled with a cooling modality that undergoes a phase change (e.g., ice). Refreezable gel packs are not as good as ice. To prevent cold injury, limit each application of cold to periods of 20 minutes and place a barrier, such as a thin towel, between the cold container and the skin.

There is insufﬁcient evidence to recommend for or against the use of a compression bandage to reduce edema following a closed soft-tissue injury such as a joint sprain. Assume that any injury to an extremity includes a bone fracture. Cover open wounds with a dressing if one is available. Do not move or straighten an injured extremity. If you are far from deﬁnitive health care, you may stabilize the extremity in the position found. If an injured extremity is blue or extremely pale, activate EMS immediately because this could be a medical emergency.

A victim with an injured lower extremity should not bear weight until advised by deﬁnitive health care. FSM