chapter 7 before providing care and victim assessment
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Chapter 7Before Providing Care and
Victim Assessment
Bloodborne PathogensBacteria and viruses present in blood and body
fluids that can cause disease in humans.
Bacteria and viruses MOST COMMON forms of pathogens
Found almost everywhere in our environment.
Bacteria vs. VirusesBACTERIA
Live can live outside of the body Commonly do NOT depend on other organisms of
lifeAntibiotics and other medications often are used
to treat the infection
VIRUSESDepend on other organisms to liveOnce viruses are in the body, they are difficult to
killPrevention is CRITICAL
Hepatitis B
Liver infection caused by the hepatitis B virus.
Severe or even fatal can be in body for up to 6 months before symptoms appear.
Prevention: Hepatitis B vaccine (3 doses)
Primarily spread through direct or indirect contact with infected blood or other body fluids
Hepatitis C
Liver disease caused by the hepatitis C virus
Most common chronic bloodborne infection in US
No vaccine against hepatitis C and NO treatment available to prevent infection after exposure
Leading cause of liver transplants
Primarily spread through direct or indirect contact with infected blood or other body fluids
HIV
Virus that causes acquired immunodeficiency syndrome (AIDS)
Weakens the body’s immune system
People with AIDS eventually develop life-threatening infections and can die from these infections.
Currently NO vaccine against HIV
Primarily spread through direct or indirect contact with infected blood or other body fluids
How Pathogens SpreadFor any disease to be spread, ALL four of the following conditions must be met:
1. A pathogen is present
2. A sufficient quantity of the pathogen is present to cause disease
3. A person is susceptible to the pathogen
4. The pathogen passes through the correct entry site (eyes, mouth other mucous membranes; non-intact skin or skin pierced by needle sticks, human bites, cuts, abrasions and other means)
How infections occur
Entry Site
SusceptibleQuantity
Present
Direct ContactOccurs when infected blood or body fluid from one person enters another person’s body at a correct entry site.
Example: *Infected blood splashing in the eye
*Directly touching the body fluids of an infected person and that infected blood or other body fluid enters the body through a correct entry site
Indirect ContactOccurs when a person touches an object that contains the blood or other body fluid of an infected person and matter enters the body through a correct entry site.
Example: *Soiled dressings: when a person picks up blood-soaked bandages with bare hands and the pathogens enter through a break in the skin on the hand.
*Equipment and work surfaces that are contaminated
Droplet TransmissionOccurs when a person inhales droplets from an infected person’s cough or sneeze
Example: Flu
Vector-Borne Transmission Occurs when the body’s skin is penetrated by an infectious source, such as an animal or insect bite or sting
Example: *Malaria*West Nile Virus
Risk of TransmissionVery low but should be very cautious
Neddlestick or cut exposure30% chance if unvaccinated person for Hep B
(depending on several factors)
Risk of hep c is about 2%
Risk of HIV infected blood less than 1%
OSHA Occupational Safety and Health Administration “issue regulations about on-the-job exposure to bloodborne pathogens”
Exposure Control Plan Written program outlining the protective measures that employers will take to eliminate or minimize employee exposure incidents.
Standard PrecautionsPersonal protective equipment (PPE)
Good hand hygiene
Engineering controls
Work practice controls
Proper equipment cleaning
Spill clean-up procedures
Personal protective equipment (PPE)
Breathing barriers Non-latex disposable gloves Gowns Masks Shields Protective eyewear
Guidelines for using PPE to prevent infection:Avoid contact w blood and other body fluidsUse CPR breathing barriers when giving
ventilationsWear disposable gloves when providing care
Disposable Gloves
Gown
Mask Protective Eyewear
Bleeding control with spurting blood
Yes Yes Yes Yes
Bleeding control with minimal bleeding
Yes NO NO NO
Emergency childbirth Yes Yes Yes Yes
Oral/nasal suctioning; manually clearing airway
No No No, unless splashing is likely
No, unless splashing is likely
Handling and cleaning contaminated equipment and clothing
Yes No, unless soiling is likely
No NO
Recommended Protective Equipment against Hep B, Hep C, and HIV transmission in prehospital settings
Good hand hygiene Most effective measure to prevent the spread of infection Wash hands frequently (for at least 15 seconds)
Engineering controls- objects used in the workplace that isolate or remove a hazard
Biohazard bags and labels Personal protective equipment Sharps disposal containers Self-sheathing needles Safer medical devices
Work practice controls- things done to help reduce the risk
Placing sharp items in puncture-resistant containers Avoiding splashing, spraying, and splattering of droplets of blood Removing and disposing of soiled clothing Cleaning and disinfecting all equipment Washing hands thoroughly with soap and warm water immediately Not eating or drinking, smoking, applying cosmetics or lip balm, handling contact
lenses, or touching the eyes, mouth or nose when in an area where exposure to infectious materials is possible
Isolating contaminated areas so other employees or people do not walk through and become exposed
Equipment cleaning and Spill-clean up procedures Always clean and disinfect the equipment and surfaces used Wear disposable gloves and other personal protective equipment
when cleaning up spills Clean up spills immediately or as soon as possible after the spill
occurs Dispose of the absorbent material used to collect the spill in a
labeled biohazard container Flood the area with fresh disinfectant solution of approximately 1
½ cups of liquid chlorine bleach to 1 gallon of water and allow to stand for about 10 minutes
Use appropriate material to absorb the solution, and dispose of it in a labeled biohazard container
Scrub soiled boots, leather shoes, and other leather goods, such as belts, with soap, a brush and hot water. If a uniform is worn to work, was and dry it according to the manufacture's instructions.
If you are exposed
Clean the contaminated area thoroughly with soap and water
If you are splashed with blood or other potentially infectious material around your mouth or nose, flus the area with water.
If your eyes are involved, irrigate them with clean water, saline for 20 minutes
Report the exposure incident
Document what happened (include time date)
Seek immediate follow-up care
General Procedures for injury or sudden illness on land
1. Size up the scene Move victim only if necessary for his or her safety
2. Perform a primary assessment Obtain consent if the victim is conscious.
3. Summon EMS, if needed
4. Perform secondary assessment, if no life-threatening conditions are found.
5. Provide care for the conditions found.
6. Report, advise, and release
Size up the Scene: Determine if the scene is safe for LGs, other rescuers, victim(s) and
bystanders• Use your senses to check hazards (gas leak or fire, look for things
explosion)
Determine what caused the injury or illness Determine the number of injured or ill victims Determine what additional help may be needed Put on the appropriate PPE
Moving a victimvictim on land move only:You are faced w immediate dangerYou need to get to other victims who have more serious injuries
or illnessesIt is necessary to provide appropriate care (stairs)
MovesNon-emergency moves
Walking assist: one or two responders conscious person who simply needs assistance
Two-person seat carry: requires a second responder. Conscious person no serious injury
MovesEmergency moves:
Clothes drag: conscious or unconscious person suspected of having a head, neck, or spinal injury
Pack-strap carry: conscious and unconscious
Ankle drag: (foot drag) to move a person who is too large to carry or move in any other way.
Perform an initial assessment:
to identify any Life-threatening conditions
Checking the victim for responsiveness A person who speaks is CONSCIOUS
Breathing and pulse
Scanning for severe bleeding
Continue sudden illness on landPerform Secondary assessment
To identify additional conditions Only do it if you know that there are no life-
threatening conditions To gather additional info about injuries or
conditions that may need care Not life-threatening but could be if not cared for
Summon EMS if any of the following conditions are found:
Unconsciousness or altered level of consciousness (LOC) “confusion or drowsiness”
Breathing problems (difficulty or no breathing) Any victim recovered from underwater who may have inhaled water Chest pain, discomfort, or pressure lasting more than a few minutes
or goes away and comes back Persistent abdominal pain or pressure No pulse Severe external bleeding Vomiting blood or passing blood Severe (critical) burns Suspected poisoning Seizures in the water Seizures that last more than 5 minutes or cause injury Suspected or obvious injuries to head, neck or spine Stroke Painful, swollen, deformed areas (broken bones) or open fracture Victim's physical condition is unclear or is worsening (allergic
reaction)
Open the Airway and check for breathing and Pulse
No more than 10 secondsPerform concurrently If able to speak, airway is functioning
Opening AirwayTo check breathing and give ventilations, you must manually tilt the head or thrust the jaw to move the tongue away from the back of the throat
Head-tilt/chin lift: used when the rescuer is positioned at the victim’s side
Jaw-thrust maneuver (with head extension): used when the rescuer is positioned above the victim’s head
Jaw-thrust maneuver (without head extension) used when the victim is suspected of having an injury to the head, neck or spine
Child, tilt the head slightly past the neutral position not as far as adultInfant, tilt head to neutral position
Checking for BreathingPosition your ear over the mouth and nose so
that you can hear and feel air as it escapes while you look for the chest to rise and fall.
Agonal gasps, isolated or infrequent gasping (this is NOT breathing) assume he/she is not breathing
Checking for a pulseIf you do not find a pulse with your fingertips in
the arteries near the skin, within 10 seconds do not waste time.
Adult and child: feel for carotid pulse “place two fingers in the middle of the victim’s throat and then slide them into the groove of the neck closest to you.”
Infant: feel for brachial pulse on the inside of the upper arm between elbow and shoulder
Give 2 ventilations Victims of cardiac arrest (witnessed sudden collapse),
IMMEDIATELY begin CPR chest compressions.
Other situations drowning or another respiratory event, giving ventilations before beginning CPR is important because victims of hypoxia (deprived of oxygen) likely to experience respiratory emergencies.
Adults: unconscious and not breathing as a result of drowning, hypoxia or another respiratory problem, give the victim 2 ventilations before compressions. If unconscious and no pulse begin compressions
Child or infant: unconscious and not breathing give 2 ventilations. Only skip if you witness a sudden collapse
Scan for severe BleedingDo a quick visual scan of the victim for severe
bleeding. Head to toe scan
Additional LGs should assist by controlling the bleeding
Recovery PositionLeave the victim in a face-up position and
maintain an open airway if he/she unconscious but breathing (especially suspected spinal)
High arm endangered spine (H.A.IN.E.S):keep the airway open and clear even if a spinal injury. You are alone and have to leave victim to call for help, you cannot maintain an open and clear airway because of the fluids or vomit.
Perform secondary assessment
Victim does NOT have any life-threatening conditions, to identify any additional problems
Provide Care for the Conditions Found
Always treat life-threatening situations FIRST.
Care should be continued until EMS personnel take over
Report, Advise, and Release
Once care is given, be sure to complete incident report forms, advise the victim on next steps and release the victim to appropriate parties.
One Age does NOT fit allPurpose of the skills in this manual
Anyone approx. 12 years of age or older is an ADULT
Anyone age 1 year to about 12 years is a child
An infant is anyone younger than 1 year
AED anyone 1 to 8 years of age less than 55 pounds is an child
Call first or care firstIf alone:
Call first for : (cardiac emergencies)
Any adult or child about 12 years of age or older who is unconscious
A child or an infant who you witnessed suddenly collapseAn unconscious child or infant known to have heart
problems.Care First (proved 2 minutes of care) for: (breathing
emergencies)
An unconscious child (younger than 12 years of age) who you did not see collapse
Any victim of a nonfatal drowning
Adult Child Infant1. Tap the victims shoulder and shout, “Are you okay.”
Tap on foot
2. If no, response (Unconscious) summons EMS
3. Check for signs of life (movement and NORMAL breathing)a. If victim face down, roll victim onto back, while supporting head.b. Tilt head back and lift the chin to open airway.Look for movement and look, listen and feel for normal breathing for NO more than 10 seconds.
Head tilt not as dramatic
Very little to no head tilt
4. If no movement or breathing, give two rescue breaths with resuscitation mask. Each breath should last about 1 second and make the chest clearly rise.
5. If chest clearly rises, check for pulse, CAROTID ARTERY, for no more than 10 seconds.a. One hand on the victim’s forehead, take other hand and place two fingers on the front of the neck. Then, slide the fingers down into the groove at the side of neck.
One hand on infant’s forehead, use other hand to find the brachial pulse on the inside of the upper arm, between the infant’s elbow and shoulder
6. Quickly scan the victim for severe bleeding.
7. Care for conditions found.a. If there is movement, breathing, and pulse, place victim in H.A.IN.E.S. recovery position (if spinal is suspected) continue to monitor ABCs (airway, breathing, circulation)
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