First Aid CPR
Law Enforcement and
Emergency Medical Services
Officer Roles and Responsibilities
Introduction
The first officer at the scene of an emergency situation assumes the role of First Responder.
Primary responsibilities
As EMS First Responders, officers should assume the primary responsibility for:
evaluating the emergency situation,
ensuring officer safety as well as the safety of ill or injured individuals and the public,
taking necessary enforcement actions related to the incident, and
initiating actions regarding the well-being and care of ill or injured persons.
Scene evaluation
At the scene officers should evaluate the nature of the incident and communicate critical
information to dispatch and other involved staff as soon as possible. The following list
identifies a number of factors that may be considered when evaluating the scene:
Location
Type of emergency
Nature of ill/injured person(s)
Need for additional resources
Officer Roles and Responsibilities, continued
Urgent enforcement actions required
Safety
Officers are responsible for taking action to protect their own safety as well as the safety of
other EMS personnel, the ill or injured person, the public, and to control the scene.
When determining appropriate safety precautions to take, officers should consider possible
dangers from:
Assessment and care of victim
By nature of their training, officers should be capable of assessing the medical condition of
any ill or injured person at the scene of an emergency.
Based on this initial assessment, officers may be required to provide basic care for the victim.
Such care may include providing basic emergency medical services until relieved of the
responsibility by other personnel with equal or higher levels of training.
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Enforcement actions
If the care and well being of the victim has been turned over to other EMS personnel, officers
may be required to continue additional enforcement actions including:
Officer Welfare and Safety
Introduction - Officers and all others within the EMS system must take appropriate
precautions at all times when in direct contact with injured victims blood or body fluids.
Pathogens - Infection and disease are caused by pathogens that are spread through the air or
by contact with another person’s blood or body fluids.
Bacteria - are microscopic organisms that can live in water, soil, or organic material, or
within the bodies of plants, animals, and humans. The human body contains a number of both
beneficial and harmful bacteria. Only when a bacteria is harmful would it be considered a
pathogen.
Virus - is a submicroscopic agent that is capable of infecting living cells.
Once inside the cells of plants, animals, or humans, viruses can reproduce and cause various
types of illness or disease.
Transfer of pathogens - There are two primary methods by which pathogens can be
transferred from one human being to another.
Airborne pathogens - are spread by tiny droplets sprayed during breathing,
coughing, or sneezing. Airborne pathogens can be absorbed through the eyes or when
contaminated particles are inhaled.
Blood borne pathogens - may be spread when the blood or other body fluids (e.g.,
semen, phlegm, mucus, etc.) of one person comes into contact with an open wound
or sore of another.
Exposure - Because of the nature of their occupation, officers are at a high risk of being
exposed to both airborne and blood borne pathogens.
NOTE: Exposure does not necessarily mean an individual will contract the illness.
Personal protective equipment – Gloves, Face Masks, Body fluid protective suit, etc. By using
personal protective equipment (PPE), EMS personnel can break the chain of transmission
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and prevent possible exposure and infection. Equipment to be effective must be used and
cared for properly.
PPE disposal - Gloves, along with other equipment intended for single use, must be disposed
of in an approved manner according to manufacturer recommendations after use or
contamination. Disposal may include but not be limited to use of:
NOTE: Officers are responsible for being aware of and complying with their agency’s
policies and guidelines regarding the disposal of hazardous PPE and materials.
Universal precautions - Along with using personal protective equipment, there are a number
of universal precautions that officers as First Responders in the EMS system should take.
NOTE: A solution of one part bleach and ten parts water can be used when disinfecting
equipment.
Personal preventive measures - Officers should also be aware of personal preventive measures
they may take to remain healthy and support their own immune systems. Staying in good
physical condition can help breach the chain of transmission of pathogens to which they may
be exposed.
Documentation of exposure - If a peace officer is exposed to an infectious pathogen (or even
suspects exposure), no matter how slight, that officer should report the exposure verbally and
in writing as soon as possible.
NOTE: Officers should be aware of and comply with their agency policies or guidelines
regarding reporting exposure and specific actions to be taken.
Legal Protections Regarding Emergency Medical
Services
Introduction - Under certain specified conditions, peace officers are afforded qualified
immunity from liability when rendering emergency medical services at the scene of an
emergency.
Responsibility to act
As trained professionals, officers have a responsibility to:
An officer is not required to render care when reasonable danger exists (e.g., while under
fire, exposure to hazardous materials, etc.).
Immunity from liability
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The California Legislature has declared that emergency rescue personnel qualify for
immunity from liability from civil damages for any injury caused by an action taken when
providing emergency medical services under certain specified conditions. (Health and Safety
Code Section 1799.102)
To be protected from liability for civil damages, emergency rescue personnel must:
Emergency rescue personnel means any person who is a peace officer, employee or member
of a fire department, fire protection, or firefighting agency of the federal, state, city, or
county government.
Emergency medical services include, but are not limited to, first aid and medical services,
rescue procedures and transportation, or other related activities necessary to ensure the health
or safety of a person in imminent peril.
Negligence - If peace officers attempt to provide emergency medical services beyond the
scope of their training, or if they act in a grossly negligent manner, they can be held liable for
any injuries they may cause.
Failure to provide care, even though the officer has had the appropriate level of training to do
so, may also lead to the officer being liable for any injuries caused because of lack of care
(e.g., not providing CPR to a victim who is HIV positive).
NOTE: Peace officers are responsible for complying with their agency policies regarding
providing emergency medical services.
Expressed consent - Officers should clearly identify themselves and ask for consent to
administer emergency medical services. Consent (i.e., permission) must be obtained from the
ill or injured person before providing emergency care.
In order to give lawful consent, the ill or injured person must be:
Refusal of care - A conscious and competent adult has the right to refuse any emergency
medical services offered by emergency rescue personnel. The refusal must be honored as
long as the person is mentally competent. Depending on specific agency policy or guidelines,
an individual who refuses emergency medical services may be required to sign a release form
relinquishing EMS personnel of responsibility for that individual.
Implied consent - A legal position that assumes that an unconscious or confused victim
would consent to receiving emergency medical services if that person were able to do so.
Emergency rescue personnel have a responsibility to administer emergency medical services
under implied consent whenever a victim is:
NOTE: Whenever implied consent is assumed or if medical services are provided based on
the seriousness of the victim’s condition, emergency rescue personnel should carefully
document the conditions or the basis for their decision to treat the victim.
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Life threatening conditions - If it is determined that an illness or injury is such that if left
untreated the victim’s condition will degenerate to a life-threatening condition, the
emergency rescue personnel may provide medical services regardless of the victim’s
conscious condition.
NOTE: Individuals who are terminally ill may have given specific do not resuscitate (DNR)
instructions. Officers are responsible for being aware of and complying with their own
agency’s policies and guidelines regarding following such instructions in an emergency
situation.
Duty to continue - Once an officer initiates medical services, that officer must remain with the
victim until:
T he officer is relieved by an individual with equal or greater training and skill
The scene becomes unsafe for the officer to remain.
Victim Assessment:
Introduction - Once the emergency scene has been evaluated and necessary safety
precautions taken, the next step for an EMS First Responder is to assess the victim’s
condition. The purpose of this two-part assessment process is to identify and immediately
treat life-threatening conditions and to set priorities for further treatment.
Two part process
There are two parts to the victim assessment process: the primary survey and the
secondary survey.
Primary Survey
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Rapid (30-45 seconds), systematic process to detect life threatening conditions
May also be referred to as the initial survey
Secondary Survey
Systematic examination to determine whether serious conditions exist.
May also be referred to as the focused survey
Respiration rate - The act of breathing is called respiration.
Responsiveness - Before taking any action, the victim’s level of responsiveness (mental
status) should be determined. To determine responsiveness, the officer should speak with the
victim directly, asking, “Are you okay?” If the victim does not respond, the officer should tap
the victim or shout in order to elicit a response from the victim. Depending on the level of
responsiveness, a victim may be determined to be:
alert, awake and oriented (i.e., can talk and answer questions),
responsive to verbal stimuli (e.g., talking or shouting), or
responsive to painful stimuli (e.g., tapping or pinching, rubbing).
IF the victim is...
THEN the officer should...
not responsive
activate the EMS system, and
check the victim’s CABs.
Victim Assessment: Primary Survey, Continued
responsive
control any major bleeding,
treat for shock, and
activate the EMS system if necessary.
CABs When a victim is alert and able to speak, it can be assumed that the victim has a clear
airway and is able to breath. If the victim is unable to speak or not responsive, then
appropriate steps should be taken to check the victim’s CABs.
Circulation The presence of a carotid pulse, taken at a carotid artery, is the most reliable
indication that the victim’s heart is functioning.
Place an index and middle finger on the front of the victim’s throat at the largest
cartilage of the larynx (“Adam’s apple”).
Slide fingers off the victim’s throat to the side of the neck toward the officer.
Position fingers between the trachea (“windpipe”) and the large muscles on the side
of the victim’s neck for five to ten seconds.
NOTE: For infants under one year, circulation should be assessed on the brachial artery
(inside upper arm between biceps and triceps).
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IF the victim
has...
THEN the officer should...
no pulse
begin cardiopulmonary resuscitation (CPR).
a pulse but is not breathing
give the victim two full breaths
each approximately 1 seconds long.
NOTE: If the first breaths do not go in, reposition the airway and try to ventilate
again. If the breaths do not go in the second time, use the appropriate technique to
force the obstruction from the airway.
a pulse, is breathing, but unconscious
check for indications of life-threatening conditions (e.g., major bleeding, shock, etc.).
place the victim in the recovery position (on the side with the head supported by the
lower forearm), if appropriate, to aid breathing and allow fluids or vomitus to drain
from the mouth.
a pulse, is breathing, and conscious
check for indications of life-threatening conditions (e.g., major bleeding, shock, etc.).
Airway - The airway is the passageway by which air enters and leaves the lungs. An airway
obstruction may be caused by the position of the victim’s tongue, head, or jaw, or some type
of obstruction in the victim’s throat. The following table identifies basic actions associated
with opening a victim’s airway:
Use a head-tilt/chin-lift maneuver to lift the tongue away from the air passage.
Breathing - After ensuring that the victim’s airway is clear and open, the responding officer
should determine if the victim is breathing.
Take a position with the officer’s ear near the victim’s mouth and eyes looking
toward the victim’s chest.
Check for breathing for five seconds by:
Victim Assessment: Primary Survey, Continued
Life-threatening conditions - Once it is determined that the victim is breathing and has a
pulse, the officer must control any major bleeding and treat the victim for shock. Such
conditions must be treated first before any further assessment of the victim takes place.
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NOTE: Techniques for administering emergency first aid measures for controlling bleeding,
treatment for shock, and other conditions are noted in later sections.
Multiple Victim Assessment
Introduction In some emergency situations, there will be more than one victim. In such
situations, it is the officer’s responsibility as EMS First Responder’s to classify the victims
for treatment. By doing so, treatment will be rendered first to those victims needing
immediate attention for life-threatening conditions.
Classification categories
Officers should move from one victim to another, making a quick (less than one minute)
assessment of each victim’s condition and classifying each victim into a category.
The following table identifies the classification categories:
Category Action
NONSALVAGEABLE - No further action (obviously dead or not breathing)
IMMEDIATE - Receives treatment first, once all victims are classified
DELAYED - Receives treatment once all victims classified as IMMEDIATE have been
treated
MINOR - Directed to a safe area away from other victims and possible scene safety hazards
Assessment criteria
Classification categories should be based on assessment of that victim’s breathing,
circulation, and mental status.
The following table describes the order of the assessment process and criteria for classifying
each victim:
Actions IF... THEN...
Breathing
Clear airway if necessary.
Measure respiration rate.
no respiration - classify victim as NONSALVAGEABLE
.
over 30 cycles/min.
classify victim as IMMEDIATE.
below 30 cycles/min.
continue assessment by checking the victim’s circulation.
Circulation - Take radial pulse or capillary refill on extremities.
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pulse absent
classify victim as NONSALVAGEABLE
pulse present
continue assessment by checking the victim’s mental status.
Multiple Victim Assessment, continued
Mental Status
Give simple commands such as “Open your eyes,” or “Close your eyes.”
unable to follow commands
classify victim as IMMEDIATE.
Follows commands
classify victim as DELAYED or MINOR.
Begin treatment - After completing the assessment and classification of all victims, treatment
of victims classified as IMMEDIATE can begin.
Moving a Victim
Introduction As an EMS First Responder, one of the most difficult decisions an officer may
need to make at an emergency scene is whether or not to move a victim.
DO NOT MOVE - More harm can be done to a victim through moving that person than by
the original injury. This is especially true if a spinal cord injury is suspected.
DO NOT MOVE - any injured victim unless it is absolutely necessary.
An unconscious, injured victim should be treated as though the victim has a spinal injury and
therefore should not be moved unless it is absolutely necessary.
Conditions for moving a victim - A victim should be moved only when the victim is in a life-
threatening situation.
Imminent danger
Unable to assess
When it is not possible to do a primary survey (CABs) of the victim’s condition
When the victim’s condition or an officer’s ability to provide basic life-saving
procedures is not possible due to the victim’s position
Slumped over a steering wheel
When CPR is required
General guidelines
If an injured person must be moved, officers should consider the following guidelines.
Plan Ahead
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Identify a safe location before attempting to move the victim.
Move only as far as is absolutely necessary.
Reassure Victim
Tell the victim(s) what is going on and why the victim is going to be moved.
Keep the victim as calm as possible.
Victim Stability
Keep victim in a straight line during the movement.
Keep victim lying down.
Move the victim rapidly but also as carefully and gently as possible.
Be careful not to bump the victim’s head during movement.
NOTE: If an infant is fastened in an infant seat, do not remove the infant. Move infant and
the seat together.
Moving a Victim, continued
Shoulder drag
A number of different techniques may be used to move an injured victim. One maneuver that
may be used is the shoulder drag technique. It can be done if the victim is in either a supine
(face up) or prone (face down) position.
To avoid straining their backs when dragging a victim, officers should:
bend their knees
keep their backs straight
let their leg muscles do most of the work.
The basic steps for the shoulder drag technique are noted below:
Step / Action
1. Use hands and grasp the victim under the armpits.
2. Stabilize the victim’s head and neck to reduce the risk of injury.
3. Carefully lift the victim keeping the head and shoulders as close to the ground as
possible.
4. Drag the victim so that the head, torso, and legs remain in a straight line.
5. DO NOT pull sideways.
6. Gently place the victim in the new location.
7. Assess the victim’s condition.
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Basic Life Support
Officers may be required to provide basic life support for a victim, fellow officer, or
themselves until additional medical services become available.
Assess breathing
Once the victim’s airway has been opened, officers must assess whether or not the person is
breathing. This is done by checking for breathing:
looking for the rise and fall of the chest
listening for the sound of breathing, and
feeling for breath from the victim’s nose or mouth.
Ventilation
If it is determined that the victim is not breathing, officers should:
give two full slow breaths
each approximately 1 second long.
If the breaths do not go in, the victim’s airway should be repositioned and ventilation should
be repeated. If the breaths still do not go in, officers should look for an airway obstruction.
Airway obstructions
An airway obstruction can be either partial or complete. They are caused by a number of
different materials blocking the person’s air passages. Examples include, but are not limited
to the following.
Victim’s tongue
Vomitus or blood
Blood
Broken teeth or dentures
Foreign objects such as toys, ice, food
Partial airway obstruction - If the victim indicates an airway problem (i.e., choking) but is able
to speak or cough, the victim is experiencing a partial airway obstruction. With a partial
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airway obstruction, it may be assumed that there is adequate air exchange to prevent
respiratory failure. A victim who is conscious with a partial airway obstruction should be
encouraged to cough forcefully to dislodge and expel the object.
Do not interfere with the victim’s attempts to cough. (e.g., pound on the victim’s back). This
could lodge the obstruction even further, causing a
Complete airway obstruction - If the obstruction cannot be removed by coughing and the
victim has labored breathing, is making unusual breathing sounds, or is turning blue/grey, the
victim should be treated as if there is a complete airway obstruction.
NOTE: Grabbing the throat with one or both hands indicating the victim is unable to breath is
considered the universal choking sign.
Basic Life Support, continued
Complete obstruction - The victim may be experiencing a complete airway obstruction if:
unconscious and unable to be ventilated after the airway has been opened, or
conscious but unable to speak, cough, or breathe.
Under such conditions, additional measures may be required to free the victim’s airway from
a complete obstruction. The two primary maneuvers used are the abdominal thrust and the
chest thrust.
Removing obstruction - If any object causing the obstruction can be seen it might be removed
by using a finger sweep.
To conduct a finger sweep:
open the victim’s mouth by grasping both the tongue and lower jaw between the
thumb and fingers,
insert the index finger of the other hand down along the cheek and then gently into
the throat in a “hooking” motion, and
if the object can be felt, grasp it and remove it.
NOTE: The finger sweep maneuver should be done with care so that the object is not forced
further into the victim’s throat.
NOTE: Do not use a blind finger sweep. Objects should be removed from their mouths only
if the objects can be seen clearly.
Abdominal thrust - The abdominal thrust (also referred to as the Heimlich maneuver) is one
method used to force obstructions from a victim’s airway that cannot be removed with a
finger sweep. Abdominal thrusts force air out of the lungs, expelling the obstruction, and
clearing the victim’s airway.
NOTE: For the purposes of this course, an adult is eight years and older; a child is one to
eight years.
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Conscious choking adult or child
1. Ask the victim, “Are you choking?”, “Can I help you?”
2. Determine that the victim is choking (i.e., unable to speak, cough, or breathe).
3. Inform the victim before taking action.
4. Take a position behind the victim.
5. Wrap arms around the victim’s waist and locate the victim’s navel.
6. Make a fist with one hand.
7. Place the thumb side of the fist against the midline of the victim’s abdomen, above
the navel.
8. Grab fist with other hand.
9. Apply pressure inward and upward toward the victim’s head in a smooth, quick
movement.
10. Repeat thrusts until object is expelled or victim loses consciousness.
Basic Life Support, continued
Chest thrusts - The chest thrust is another maneuver that can be used to force obstructions
from a victim’s airway. Chest thrusts are used when the victim:
has gone unconscious
is in late stages of pregnancy
has abdominal injuries
is too obese for abdominal thrusts to be effective.
Unconscious adult or child
1. Activate the EMS system.
2. Place victim in a supine position. ( On their back)
3. Open the victim’s airway.
4. Remove any visible obstruction. (Do not use a blind finger sweep.)
Attempt to ventilate victim’s lungs.
If airway remains obstructed, reposition the victim’s head and attempt to ventilate
again.
If airway remains obstructed, Begin CPR.
Two hands in the center of the chest at the imaginary nipple line for an adult/child.
For Adult - Place the heel of the hand closest to the victim’s feet on top of the heel of
the other hand at the compression point.
For Child - Place one or two hands (depending on officer/victim size and strength
factors) at the compression point.
Straighten and lock elbows.
Position shoulders directly above hands.
Using body weight, push straight down with enough force to compress the sternum at
least 2 inches for an adult.
If victim is a child, compress the sternum 1/3-1/2 the depth of the chest.
Fully release compression pressure in the same amount of time it took to apply it.
Deliver 30 compressions at a rate of at least 100 per minute.
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Infants - A combination of back blows and chest compressions may be used to clear a
foreign body from an infant’s airway. The following table identifies techniques
for chest thrusts on both conscious and unconscious infants:
NOTE: For the purposes of this course, an infant is newborn - one year.
Conscious choking infant
Step / Action
1. Confirm that the infant’s airway is obstructed (serious breathing difficulty,
ineffective cough, absence of a strong cry).
2. Do not attempt to ventilate or conduct a finger sweep.
3. Support infant’s body on forearm, face down. (The officer’s arm may be resting
on one leg for additional support.)
Basic Life Support, continued
4. Place infant’s face in the palm of the hand with the infant’s nose between the
forefinger and middle finger.
5. Position the infant’s head lower than the body.
6. Using the heel of one hand, deliver up to five blows to the infant’s back between
the shoulder blades.
7. If the airway remains obstructed, turn infant over so that the back of the infant’s
head is supported by the hand.
8. Keep the infant’s head lower than the body.
9. Place fingers of one hand on the center of the infant’s chest, one finger width
below the nipples but above the xiphoid process.
10. Deliver five chest thrusts to compress the infant’s chest 1/3-1/2 the depth of the
chest.
11. If the airway remains obstructed, alternate between five back blows and five chest
thrusts until the obstruction is clear or the infant loses consciousness.
Unconscious infant
1. Activate the EMS system.
2. NOTE: Officers should have a second person (if available) activate the EMS
system, while the officers begin the maneuver immediately.
3. Position infant on its back.
4. Carefully, open the infant’s airway.
5. Look in the infant’s mouth.
6. If obstruction is visible, carefully remove it.
7. If airway remains obstructed, reposition the infant’s airway and attempt to
ventilate.
8. If air does not enter the infant’s airway, reposition the infant’s airway and attempt
to ventilate a second time.
9. If airway remains obstructed, Begin CPR.
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10. Using 1-2 fingers, find the compression point one finger width below the
imaginary nipple line.
11. Compress the sternum 1/3-1/2 the depth of the chest.
12. Fully release compression pressure in the same amount of time it took to apply it.
13. Deliver 30 compressions at a rate of at least 100 per minute.
Rescue Breathing
Introduction If it is determined that a victim’s airway is open and no obstructions are present,
yet the victim is still not breathing, the officer may attempt rescue breathing.
Rescue breathing - is the process of using one’s own breaths to artificially breathe for a
victim. The rescue breathing process continues until the victim is able to breathe without
assistance or other breathing support is provided by EMS personnel.
Scene safety - Ensure scene safety by taking universal precautions.
Responsiveness
Establish that the victim is unresponsive.
Activate the EMS system. (If a second person is available, have that individual
activate the EMS system.)
Checking CABs
Prior to beginning rescue breathing, a primary survey of the victim should take place. The
primary survey should include determining the victim’s responsiveness as well as checking
the victim’s CABs.
Circulation to identify if the victim has a pulse.
Airway to ensure the victim’s airway is open,
Breathing to determine if the victim is breathing (If it is determined that the victim is
not responsive, has a pulse, has an open airway, but is not breathing, then rescue
breathing may be required.)
Rescue breathing technique
Open the victim’s airway using the head-tilt/chin-lift or jaw-thrust maneuver
(whichever is most appropriate for the situation.).
Portable pocket mask
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o nose.
Take a breath and slowly exhale directly into the victim’s mouth or through the one-
way valve of the mask.
Use only enough air to create a gentle rise in the victim’s chest.
Break contact with the victim’s mouth or the mouth piece of the mask.
Rescue Breathing, continued
Watch the victim’s chest as the air is released from the victim’s lungs.
If breaths do not enter the victim’s lungs: reposition the victim’s head to open the
airway, attempt to breathe into the victim’s lungs again.
Repeat the breathing cycle until the:
NOTE: If the victim begins to breathe without assistance, continue to assess the victim’s
condition and provide care for shock.
Other conditions
If the victim’s mouth is injured and cannot be used for rescue breathing, the officer should
use a mask-to-nose position.
If the victim has a laryngectomy, a surgical procedure that implants an artificial airway
(stoma) in the neck, the officer should use a mask-to-stoma position.
For both positions, the same methods should be used as with mouth-to mouth/face mask
techniques for rescue breathing.
Rescue breathing rates and duration
Rescue breathing duration and rate will vary depending on the victim’s age.
Adult (8 years and older) = 1 breath every 5-6 seconds.
Child (1 - 8 years) = 1 breath every 3-5 seconds.
Infant (newborn - 1 year) = 1 breath every 3-5 seconds.
NOTE: Officers should use their best judgment when estimating the age of a child or infant.
Reassessing: Reassessment should be completed every two minutes. CAB’s should be checked
every two minutes.
If the victim is:
has no pulse, begin cardiopulmonary resuscitation (CPR).
has a pulse but not breathing, continue rescue breathing.
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Rescue Breathing, continued
Recovery position
If the victim resumes adequate breathing and there are no indications of major bleeding or
spinal injury, then the victim can be placed in the recovery position.
This position allows for drainage from the mouth and prevents the victim’s tongue from
blocking the airway.
To place a victim in the recovery position:
roll the victim onto either side toward the officer,
keep the victim’s body in one unit with the spine as straight as possible,
move the victim’s lower arm up and bend at the elbow,
rest the victim’s head on the lower forearm,
move the victim’s top leg toward the victim’s chest, and
continue monitoring the victim’s breathing.
Vomiting - If a victim vomits, the vomitus may enter the lungs and cause further life
threatening complications.
If vomiting should occur:
turn the victim’s entire body (not just the head) to the side as one unit to keep the
spine straight,
wipe the vomitus from the victim’s mouth,
return the victim to the supine position,
re-open the airway, and continue rescue breathing.
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Cardiopulmonary Resuscitation (CPR)
Introduction If a victim is unresponsive, not breathing, and has no carotid pulse to indicate
circulation, then the victim is in a state of cardiac arrest. Without immediate care, the victim
will die.
CPR Cardiopulmonary resuscitation (CPR) is a method of artificially restoring and
maintaining a victim’s breathing and circulation. CPR is a key element of basic life support.
In order to survive, oxygenated blood must circulate through the body and reach the victim’s
brain. In order to ensure that this process takes place, an officer must:
physically force the victim’s blood to circulate (external chest compressions).
maintain an open airway,
breathe for the victim (rescue breathing)
Clinical and biological death
A victim is clinically dead the moment breathing and circulation stop. Clinical death may be
reversible if basic life support techniques such as CPR are begun immediately.
When a victim’s breathing and circulation stop and brain cells die due to lack of oxygen,
irreversible changes begin to take place, and vital organs begin to deteriorate. At this point, a
victim is biologically dead. Biological death usually takes place within four to six minutes
after breathing and circulation stop.
NOTE: If any doubt exists as to whether or not the victim is alive, CPR should be started.
NOTE: The point at which a victim is considered to be biologically dead may be defined by
specific agency guidelines and policy.
“Do not resuscitate” orders
A valid “do not resuscitate” (DNR) or “no-CPR” directive would also be a reason for not
beginning CPR on a victim. If there is any doubt that the order may not be valid or if a family
member requests that an order be ignored, CPR should be started.
Specific agency policy
Different agencies may have specific policies and guidelines regarding performing CPR on
unconscious adults, children, and infants, or DNR orders. Officers are responsible for
knowing and complying with their agency policies.
Checking CABs
Prior to beginning CPR, a primary survey of the victim should take place. The primary
survey should include determining the victim’s responsiveness as well as checking the
victim’s CABs.
C irculation to identify if the victim has a pulse
A irway to ensure the victim’s airway is open
B reathing to determine if the victim is breathing
If the victim does not has a pulse (circulation), begin CPR immediately!
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Cardiopulmonary Resuscitation (CPR), Continued
Adult/child CPR:
Once a peace officer has confirmed the victim’s mental state, conducted a primary survey,
and has determined that there is no breathing or circulation, CPR should begin immediately.
NOTE: For the purposes of CPR, a child is defined as one to eight years.
Actions
1. Responsiveness
Establish that the victim is unresponsive.
Activate the EMS system. (If second person is available, have that individual activate
the EMS system.)
2. Position
Place victim in a supine position on a firm surface.
3. Pulse
Check for a carotid pulse over a five to ten second time period.
If victim has:
4. Compression Point
NOTE: External compressions are not effective unless performed in the correct position.
Compressions to the wrong part of the chest may lead to further injury of the victim.
5. External Compressions
Straighten and lock elbows.
Position shoulders directly above hands.
Using body weight, push straight down with enough force to compress the sternum at
least 2 inches.
If victim is a child, compress the sternum 1/3-1/2 the depth of the chest.
Fully release compression pressure in the same amount of time it took to apply it.
Deliver 30 compressions at a rate of at least 100 per minute.
(Count out loud “1, 2, 3, ....”)
Adult/child CPR: one person (continued)
6. Airway
Open the victim’s airway using head-tilt or jaw-thrust maneuver.
Check for breathing. Look, listen, and feel for breathing once the airway is open.
NOTE: If already breathing or breathing resumes effectively once the airway is opened, place
victim in a recovery position, when appropriate.
7. Initial Ventilation
19
If available, use a pocket face mask for ventilation during CPR.
Give two breaths with each lasting 1 second.
Blow into the victim’s mouth until resistance is noted. (Feel for resistance orally and
watch for the victim’s chest to rise.).
Allow victim to exhale between breaths.
8. Ventilation/Compression Cycle
After 30 compressions, reposition victim’s airway.
Give two slow, full breaths.
Continue cycle of 30 compressions to 2 breaths for 5 cycles (approximately 2
minutes).
9. Assessment
Assessment/reassessment should be done every 5 cycles or 2 minutes.
Recheck carotid pulse and look, listen, and feel for breathing over a period of five
seconds.
If victim has:
Infant CPR
The technique for performing CPR on an infant (newborn to one year of age) is similar to
that for adults, but with adjustments that take into accounts the infant’s size.
Actions
1. Responsiveness
Establish that the victim is unresponsive.
If second person is available, have that individual activate the EMS system. (If officer
is alone, begin CPR immediately.)
2. Position
Place victim in a supine position on a firm surface.
Infant CPR: one person (continued)
3. Airway
Gently open the victim’s airway using head-tilt maneuver. (Do not over extend the
infant’s neck.)
Check for breathing. Look, listen, and feel for breathing once the airway is open.
4. Initial Ventilation
Give two, gentle puffs of air with each lasting 1 second until the victim’s chest visibly
rises.
Allow victim to exhale between breaths.
20
5. Pulse Check for a brachial pulse over a five second time period.
If victim has:
6. External Compressions
Locate compression point on the victim’s breastbone, one finger width below the
imaginary line between the nipples.
Using two fingers only, depress the victim’s breast with enough force to compress the
sternum 1/3-1/2 the depth of the chest.
Deliver 30 compressions at a rate of at least 100 compressions per minute.
Follow with two breaths(puffs) (30 compressions to two breaths).
7. Assessment
Check brachial pulse after two minutes.
If victim has:
8. Stopping of CPR
CPR must be continued until:
the victim’s breathing and circulation resumes,
the officer is relieved by an equally or higher medically trained person,
the officer is too exhausted to continue,
environmental hazards endanger the rescuer (e.g., gun shots),
continued CPR efforts would endanger the lives of others, or it is determined the
victim is biologically dead.
Bleeding Control
Introduction Large or deep wounds or injuries can lead to uncontrolled bleeding, which in
turn can lead to shock and eventually death.
Circulatory system
The three components to the human circulatory system are the:
heart,
blood vessels, and
blood.
If any one component does not function properly, oxygen and nutrients will not reach the
body’s major organs in sufficient enough supply to support life.
Bleeding control techniques
There are four techniques that may be used to control or limit bleeding at the scene of a
medical emergency.
1. Direct pressure
Direct pressure applied to the bleeding site until bleeding is controlled
Use of a bandage to hold a pressure dressing in place
Most common and effective technique
Should be used first before other bleeding control options
May be done by firmly applying direct pressure over the bleeding site using clean
dressing
NOTE: If clean dressing is not available, a gloved hand or other clean material may be used.
21
2. Elevation
Use of gravity to help reduce blood pressure to the site and slow the bleeding
Elevate bleeding site above the level of the heart
Used in combination with direct pressure
NOTE: Should not be used if a fracture to that limb or a spinal cord injury is suspected.
3. Pressure Points
Applying direct pressure to a specific location where an artery is close to the body
surface and near a bone
Used when bleeding is not controlled through pressure, elevation, or pressure
bandage
Brachial artery
Used to control bleeding from upper limbs
Pressure is applied by placing the pads of fingers into the groove between the victim’s
biceps muscle and bone
Pressure should be maintained until bleeding is controlled
Femoral artery
Used to control bleeding from lower limbs
Pressure is applied by placing the pads of fingers into the crease between the victim’s
abdomen and leg
Pressure should be maintained until bleeding is controlled
Bleeding Control, Continued
4. Tourniquet
Use of a device to close off all blood flow to and from a limb
Should only be used for life threatening conditions as a last resort when all other
methods have failed
Can be made of any material wide enough (at least 2 inches) so as to not cut into
the victim’s skin (e.g., flat belt, stocking, necktie, etc.)
Apply close to the wound, between the wound and the victim’s heart (but not over
a joint)
Wrap material around limb and draw tightly to the point where the bleeding is
stopped and no further bleeding occurs. Note the time the tourniquet is placed;
report to EMTs
If victim is covered, leave the area where the tourniquet is located exposed for
EMTs to see
Tourniquet should not be loosened or removed once in place
NOTE: A dressing is any material applied to a wound to control bleeding and prevent
contamination. A bandage is any material used to hold a dressing in place.
Bleeding Control, Continued
Open wounds
22
An open wound is any injury where the skin has been broken, exposing the tissue
underneath. Abrasions, incisions, lacerations, punctures, avulsions, and amputations are
all examples of open wounds requiring attention to control bleeding.
Abrasion - A scraping away of only outer portion of the skin
Rug burns
Road burns
Skinned elbows/ knees
Incision - Smooth, straight cut caused by sharp objects
Paper cuts
Razors
Edge weapons
Laceration - Jagged-edged wound caused by objects tearing or ripping the skin
Broken glass
Jagged metal
Saws
Severe blow or impact with blunt object
Puncture - Deep wound through the skin and other tissue
Arrows
Knives
Nails
Bullets
Impaled objects
Bleeding Control, Continued
NOTE: Penetrating punctures have only an entrance wound and can be shallow or deep.
Perforating punctures have an entrance wound and an exit wound.
Avulsion - A part or structure of the body that has been forcibly torn or cut away
Tip of nose that is cut off
External portion of ear torn away
Eye pulled from its socket
Amputation - Surgical or traumatic removal of a body extremity
Jagged skin and bone edges may be exposed
May involve massive bleeding
Accidents involving chain saws, industrial equipment, etc.
Care for open wounds
General Guidelines
Assessment
Expose the injury site before applying bleeding control (e.g., remove, loosen, or
cut away clothing covering the wound).
Assess for possible fractures associated with open wound.
23
To prevent any further contamination of the wound, do not attempt to clean the
wound before applying dressing to control bleeding.
Immediate care
Control Bleeding
Cover the entire wound site with dressing.
Apply pressure to stop bleeding.
Bandages should be applied snugly but not so tight as to impair circulation to
portions of the body distal (farther away from the torso) to the wound site.
Leave fingers and toes exposed.
Impaled Objects
Do not attempt to remove the object. (Any movement of the object could cause
further damage or increased bleeding.)
Control bleeding by applying pressure on both sides of the object.
Do not put pressure on the object itself.
Avulsions/Amputations
Place partially separated skin or tissue back in proper position before applying
dressing and bandage.
Attempt to locate any avulsed part or amputated extremity.
Keep separated part/extremity dry, cool, and protected.
Do not immerse, pack in ice, or freeze separated part/extremity.
Transport separated part/extremity with victim for possible surgical replacement
Bleeding Control, Continued
Circulation
Monitor pulse below the injury site.
Check capillary circulation by pinching fingertips or toes. (Color should return
immediately to pinched area.)
If circulation is impaired, loosen bandage (do not remove) until circulation
improves.
Continued care
If necessary, immobilize the injury site (e.g, open fracture).
Keep the victim lying still to prevent an increase in circulation.
Maintain pressure on wound.
Monitor the victim’s CABs.
Reassure the victim. (Fear and anxiety can increase a victim’s heart rate and
circulation.)
Treat for shock.
24
Shock
Introduction Shock is a life-threatening condition. If not immediately cared for, the victim
can die. Perfusion is the continued flow of blood through the capillaries supplying the
body’s tissues and organs with oxygen and removing waste products. Inadequate perfusion
leads to shock.
Indicators of Shock
Altered mental status
Oxygen deficiency to the brain
Pale, cool, clammy skin
Profuse sweating
Thirst, nausea, vomiting
Blue/grey lips, nail beds, tongue, ears (i.e., cyanosis)
Dull eyes, dilated pupils
Rapid pulse rate C Weak or “thready” pulse
Shallow, labored breathing
NOTE: There may be no relationship between severity of an injury and the onset of shock.
Victims may appear to have no major injury but still show signs of restlessness or anxiety,
which are early stages of shock. For this reason, all victims of traumatic or medical
emergencies should be provided care for shock from the time of initial contact.
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Fainting is a form of shock characterized by sudden unconsciousness. It is caused by dilation
of blood vessels resulting in reduced flow of oxygenated blood to the brain.
Treating shock
All victims should be treated for shock even if no indications of shock are evident. When
providing care to treat shock, officers acting as EMS First Responders should:
control all external bleeding and treat other injuries,
gently place the victim in appropriate position,
be alert for vomiting,
maintain the victim’s body temperature but avoid overheating,
place the victim in a position to help maintain blood flow,
reassure the victim, and
continue to monitor the victim’s CABs and be prepared to take action if necessary
(e.g., rescue breathing, CPR).
NOTE: Overheating the victim may worsen shock. A blanket beneath a victim may be more
effective in reducing heat loss than one placed on top of the victim.
Shock, continued
Thirst - Even though the victim may be thirsty, do not give anything to drink. Shock
can cause the gastrointestinal system to shut down. Fluids given orally may lead to
vomiting.
Positioning victim
During treatment for shock, the position in which the victim is placed is dependent
upon the nature of the injury or illness. If lower limb or spinal fractures are not
suspected:
place the victim in a supine position and
elevate legs approximately 6-12 inches.
26
Traumatic Injuries
Head Injuries
Introduction Any person who has suffered a traumatic injury may also be subject to a
possible brain or spinal cord injury. For this reason, officers, acting as EMS First
Responders, should treat all traumatic injury victims as if they have a head injury.
Indications of head injury
Head injuries can involve injuries to the skull, scalp, brain, blood vessels and fluid around the
brain, and/or neck. They may vary from those involving minor bleeding to those leading to
life-threatening conditions and spinal cord injury.
Indications of Possible Head Injury
Striking a vehicle’s windshield or dashboard
Blow to the head
Falls
Mental Status
Agitated or confused
Combative or appears intoxicated
Decreased level of consciousness (e.g., appears “groggy”)
Loss of short term memory
Loss of consciousness (even for a short period of time)
Vital Signs
Abnormal breathing patterns
27
Decreased pulse
General deterioration of vital signs
Visible Injury
Deformity of head/skull (e.g., protrusions, depressions, swelling, bruising, etc.)
Visible bone fragments
Indications of Possible Head Injury Appearance
Clear or bloody fluid from ears and/or nose
Unequal pupils
Bruises behind ears (i.e., “battle scars”)
Discoloration around eyes (i.e., “raccoon eyes”)
Paralysis
Blurred vision
Projectile vomiting
NOTE: The extent of a head injury may not always be obvious. Whenever a victim has
suffered a traumatic head or neck injury, brain and spinal cord damage should always be
assumed.
Head Injuries, Continued
First Aid Measures for Head Injuries
Position
Do not move the victim’s head or neck.
Have the victim remain in the position in which found.
Assessment
Determine level of consciousness.
Conduct a primary and secondary survey.
If necessary, use the jaw-thrust maneuver to open victim’s airway.
Treatment
Activate the EMS system.
Control bleeding if necessary.
Be alert for the presence of cerebrospinal fluid in ears or nose. If present, bandage
loosely so as not to restrict the flow.
Do not apply direct pressure to any head/skull deformity.
Be prepared for sudden and forceful projectile vomiting.
Treat for shock.
Do not elevate the victim’s legs.
Reassure the victim.
Continue to monitor CABs.
Impaled objects (Head injuries)
Unlike treatment for other situations involving impaled objects, any object (e.g., knives,
arrows, screw drivers, etc.) that is impaled into a victim’s cheek or face and may cause an
airway obstruction should be removed.
If the impaled object is obstructing the victim’s airway:
28
carefully pull the object out from the direction it entered, and place dressing on both
the inside and outside of the cheek to control bleeding.
If the object resists coming out, stop. Do not pull any farther. Place a protective
device around it to stabilize the object (e.g., paper cup) and secure the device with a
bandage.
NOTE: If there is no airway obstruction, do not attempt to remove the object.
Nosebleeds Victims with facial injuries may experience an accompanying nosebleed. If this
occurs and no spinal injury is suspected, have the victim:
assume a seated position,
lean slightly forward,
pinch the nose midway at the point where bone and cartilage meet, and
maintain the position until bleeding stops.
If the victim is unconscious:
slightly elevate the victim’s head, or
place the victim in the recovery position, if appropriate, and
maintain an open airway.
NOTE: Do not pack the victim’s nostrils. This could cause blood to back up and create an
obstructed airway.
Chest and Abdominal Injuries
Introduction Traumatic injuries to the chest or abdomen are potentially serious because of
possible damage to the lungs and vital organs.
Types of chest and abdominal injuries
Traumatic injury to the chest and/or abdomen can lead to bleeding (external and internal) as
well as damage to the lungs, heart, and other vital organs. The chest and/or abdomen may be
injured in a number of ways.
Blunt trauma
Blow to the chest and/or abdomen causing:
Penetrating object
Caused by bullets, knives, metal or glass, etc.
Can lead to:
Compression along with rapid chest and/or abdomen compression (e.g., striking a
steering wheel)
Can lead to:
Closed chest wound
Although there may not appear to be any serious injury to the chest, blunt trauma or
compression to the chest area can lead to a condition referred to as flail chest. Flail chest is
the condition where the ribs and/or sternum are fractured in such a way that a segment of the
chest wall does not move with the rest of chest wall during respiration. It is caused when two
or more ribs next to each other are broken.
Indicators First Aid Measures
29
Paradoxical breathing (when both sides of the chest do not move in a synchronized
manner)
Painful and shallow breathing
Open chest wound
All open wounds to the chest should be considered life-threatening. For respiration to take
place properly, the chest must function as a vacuum. With an open chest wound, air may
enter the chest area causing a lung to collapse (e.g., sucking chest wound with a punctured
lung). Under such conditions, the victim’s ability to breathe, and the victim’s heart function
can be greatly impaired. To prevent air from entering the chest cavity, an occlusive dressing
should be applied to the wound as quickly as possible.
Occlusive dressing
An occlusive dressing:
is a nonporous dressing (e.g., plastic bag), used to cover the wound, and
creates an air-tight seal.
NOTE: As the victim inhales, the dressing is sucked tight to the skin, providing a seal over
the wound. If the dressing is placed properly, respiration should partially stabilize.
Applying an occlusive dressing
Place a gloved hand over the wound to “seal” the wound.
Without moving the hand covering the wound, use the free hand to place a piece of
plastic over the hand covering the wound site.
NOTE: Plastic should be at least two inches wider than the wound itself.
While using the free hand to apply gentle pressure and maintain the seal around the
wound, gently remove the other hand from under the plastic.
Tape all but one corner of the plastic in place.
The untaped corner will allow air to escape from the chest cavity when the victim
coughs.
Provide care to prevent shock.
Continue to monitor the victim’s CABs.
NOTE: If the chest has both entrance and exit wounds, occlusive (airtight) dressings should
be placed on both wounds.
Closed abdominal wound
A victim with a closed abdominal wound will have no external bleeding but may have
internal bleeding that can be severe and potentially life-threatening. If a closed abdominal
wound is suspected, peace officers should initiate the following first aid measures.
Chest and Abdominal Injuries, Continued
30
Indicators First Aid Measures
Victim found lying in a fetal position (with legs pulled up to chest)
Rapid shallow breathing
Rapid pulse
Rigid or tender abdomen with or without swelling
Pain or tenderness to the touch during secondary survey
Activate EMS system.
If no spinal injury suspected, place victim in a comfortable position (e.g., supine with
knees bent up).
Treat for shock.
Continue to monitor the victim’s CABs.
Be prepared for the victim to vomit.
Open abdominal wounds
An open abdominal wound can be caused by lacerations and punctures to the abdomen.
Blood loss and the potential for infection should be of concern when dealing with an open
wound to the abdomen. If an open abdominal wound is identified, peace officers should
initiate the following first aid measures.
First Aid Measures Assessment
Determine the victim’s state of consciousness.
Conduct primary and secondary surveys.
Treatment Activate EMS system.
If no spinal injury is suspected, place the victim in a supine position with the knees
up.
Place a sterile dressing over the wound.
Apply an occlusive dressing over the dressing to prevent the wound from drying out.
Secure all sides of the occlusive dressing.
Place a thick pad or cover over the occlusive dressing to maintain additional warmth
to the abdominal cavity.
Treat for shock.
Continue to monitor the victim’s CABs.
If any organs or portion of an organ protrude from the abdominal wound, do not
attempt to touch, move, or replace them. Cover the organ and the rest of the wound
with a moist dressing and seal with an occlusive dressing.
Bone, Joint, and Muscle Injuries
31
Introduction Musculoskeletal injuries may have a grotesque appearance. Officers should not
be distracted by the injury’s appearance or begin first aid measures until an assessment is
completed and treatment for other life-threatening measures are taken.
Musculoskeletal system
The musculoskeletal system is the system of bones, muscles, and other tissue that support
and protect the body and permit movement. The components of the musculoskeletal system
include bones, joints, skeletal muscles, cartilage, tendons, and ligaments.
Description:
Bone
Hard yet flexible tissue
Provides support for the body as well as protection of the vital organs
Joint
Place where bones fit together
Proper function is critical in order for the body to move
Skeletal Muscle
Soft fibrous tissue
Controls all conscious or deliberate movement of bones and joints
Cartilage
Connective tissue that covers the outside of the ends of bones
Firm but less rigid than bone
Helps form certain flexible structures of the body (e.g., external ear, connections
between the ribs and sternum, etc.)
Allows for smooth movement of bones at joints
Tendon
Bands of connective tissue that bind muscles to bones
Ligament
Connective tissue that attaches to the ends of bones and supports joints
Allows for a stable range of motion
Musculoskeletal injuries
Types of force that can cause injury to the musculoskeletal system:
Direct - Direct blow to an area
Being struck by an automobile
Indirect - Force from a direct blow to one area which causes damage to another
Landing on feet from a fall and injuring ankles, knees, etc.
Twisting - Sudden rapid movement that stretches or tears
Football and other sport related injuries
Bone, Joint, and Muscle Injuries, Continued
32
Types of injuries
The four most common injuries are fractures, dislocations, sprains, and strains, are
identified below:
Fractures - Complete or partial break of a bone including:
open fractures where there is a break in the skin at the site of the fracture
closed fractures where there is no break in the skin at the site of the fracture
Limb deformity (differences in size or shape)
Swelling or discoloration to the area
Tenderness and localized pain
Breaking and/or grating sound
Possible loss of function
Dislocations - When a bone is pushed or pulled out of alignment from a joint
Constant pain
Increased pain with movement
Joint deformity
Swelling
Loss of movement (i.e., “frozen joint”)
Sprains - Severely stretched or torn ligaments
Associated with joint injuries
Pain
Swelling
Discoloration
Strains - Over-stretching or tearing of muscle
NOTE: Unless there is an obvious deformity or open wound with exposed bone, it is not
possible to determine whether an injury is a fracture, dislocation, sprain, or strain without X-
ray and other diagnostic procedures. When a musculoskeletal injury is suspected and the
injury is severe (i.e., fracture), peace officers should use the following first aid measures.
First Aid Measures
Assessment - Conduct a primary and secondary assessment to determine if there are any life-
threatening injuries.
Treatment
Activate EMS system, if necessary.
Do not attempt to manipulate or “straighten out” an injury.
Expose the injury by removing clothing covering the area.
Control bleeding associated with open fractures.
Stabilize the injury by immobilizing the bones above and below the joint.
Check distal pulse of affected limb.
Treat for shock.
Do not elevate legs if injury is to the lower extremities.
If treating multiple victims with fractures, treat the most life threatening fractures first
(e.g., spinal fractures, fractures involving pelvis, fractures that could lead to internal
bleeding in the body cavity), injured arm to the victim’s body, etc.).
33
Burns
Introduction A burn is an injury caused by heat, chemicals, or electricity. Burns can involve
just the outer-most layer of the skin or go deeper into structures below the skin including
muscle, bone, nerves, and blood vessels. Along with physical damage, victims with burns can
also experience great pain and emotional trauma from the injury.
Victim assessment
Prior to any first aid measures, no matter how extreme the burn, a victim assessment
including primary and secondary surveys should be conducted. Only when immediate life-
threatening conditions have been addressed, should the officer’s attention be directed to first
aid treatment for the burns themselves.
Severity - Burns involving the skin are classified according to the depth of the burn in the
tissue. Classifications include: first-degree burns, second-degree burns, third-degree
burns, and fourth-degree burns.
First-degree
Damage only to the epidermis (outer-most layer of the skin)
Also referred to as superficial burns
Skin appears red
Can be very painful
Damage usually heals without scarring
Example: mild sunburn
Second-degree
Damage to the epidermis and the dermis (second layer of the skin containing nerves,
hair follicles, and sweat glands)
Also referred to as partial thickness burns
Skin appears red and mottled (spotted)
Accompanied by blisters (plasma and fluid released from tissue that rises to top layer
of skin)
May involve swelling
Causes intense pain
May produce slight scarring
Third-degree
Damage to the epidermis, dermis, and into fatty layer and muscle beneath the skin
Also referred to as full thickness burns
Skin appears dry, leathery, and discolored (white, brown, or black)
May be extremely painful or the victim may experience little pain if nerve endings
have been destroyed
May require skin grafting to heal
Causes dense scar formation
Fourth-degree
Damage to bone and underlying organs
34
Burns, Continued
First aid measures
The most common types of burns are thermal burns, chemical burns, and electrical burns.
The following table provides a description along with appropriate first aid measures for each:
Description / First Aid Measures
Thermal Burns
Caused by direct heat
Possible causal agents
Chemical Burns
Caused by acids or alkalis coming into contact with the skin
Most frequently occurs in industrial settings
NOTE: Bandage should hold dressing in place and protect the area from contaminants.
Bandaging too tightly may not only cause pain but also restrict swelling.
Electrical Burns
Occur when the body becomes a conduit for electrical current
Sources include:
Electrical Burns, continued
May cause extensive internal injuries
NOTE: Entrance and exit wounds caused by electrical current may be difficult to see
initially. They will be found in different locations on the victim’s body. For example, if the
victim touches a live wire, current may enter the body through the hand, pass through the
body, and exit through the victim’s feet.
Electrical current and vehicles
If officers respond to calls where live power lines have fallen onto a vehicle, they should:
not touch the lines or any part of the vehicle,
instruct the occupants to remain in the vehicle, and wait for the utility company to
turn off the power before taking any action.
Occupants should not be told to leave the vehicle unless life-threatening
circumstances exist (e.g., vehicle fire).
35
Medical Emergencies
In this chapter. This chapter will focus on basic first aid measures for a variety of medical
emergencies and conditions peace officers as EMS First Responders may encounter.
Cardiac Emergencies
Introduction A cardiac emergency can range from a victim experiencing shortness of breath
or palpitations to full cardiac arrest. Swift action is necessary on the part of peace officers to
prevent death or permanent neurological injury.
Heart attack is a common term describing minor to severe conditions. Minor conditions
include blockage of blood or lack of oxygen to heart tissue, and varying levels of pain. If the
victim does not receive appropriate care immediately, the victim’s chances of survival are
greatly reduced.
Coronary artery disease (CAD) (often referred to as coronary heart disease) is a disease
where fatty deposits build up in the walls of the arteries that feed the heart’s muscle. If an
artery becomes blocked, the heart muscle will be deprived of blood and oxygen.
Other causes of cardiac emergencies
Along with coronary heart disease, there are a number of other conditions that can lead to
cardiac emergencies. Cardiac arrest may also be caused by:
drowning,
electrocution,
suffocation,
choking,
drug overdose, or
allergic reaction.
Indicators of Cardiac Emergency
Chest Pain - Crushing, dull, or heavy persistent pain (i.e., angina). Sensation of
squeezing or pressure
Radiating Pain - Pain, pressure, or discomfort moving:
Vital Signs - Difficulty breathing or shortness of breath. Abnormally slow or fast
pulse.
Mental Status - Anxiety or feeling of impending doom. Irritability or short temper.
Denial of indicators
Other - Profuse sweating, Cool, moist, pale or ashen skin. Nausea or heartburn.
First aid measures
36
Although the indicators of a cardiac emergency resemble the indicators of a number of other
medical conditions (e.g., heartburn), peace officers should always first assume that a cardiac
emergency exists, activate the EMS system (if not already activated), and take appropriate
first aid measures.
First Aid Measures for Cardiac Emergencies, continued
Assessment - Conduct primary and secondary surveys.
Treatment
Activate EMS system.
Place the victim in a comfortable position (e.g., seated, supine, etc.).
Keep the victim calm and still (even if the person denies indicators of a heart attack).
Provide care to prevent shock.
Maintain victim’s body temperature.
Continue to monitor victim’s CABs and provide reassurance until EMS personnel
arrive.
Medications Some victims with existing cardiac conditions may be taking prescription
medications for that condition. Officers should never administer any medications, prescribed
or otherwise. If victims are oriented enough to ask for or decide they need their prescribed
medication, peace officers may allow a victim to take them. Officers may assist the victim if
required (i.e., removing medication from its container and placing it in the victim’s hand).
37
Respiratory Emergencies
Introduction Respiratory emergencies may range from victims who are having breathing
difficulty, but nevertheless are breathing adequately, to victims who are not able to breathe at
a level that will sustain life.
Adequate breathing
Normal breathing rate is determined based on the person’s age.
Age Breathing Rate
Adult (8 years and older) 12-20 breaths/minute
Child (1-8 years) 15-30 breaths/minute
Infant (newborn - 1 year) 25-50 breaths/minute
Causes of inadequate breathing
There are numerous possible causes that could lead to inadequate breathing and potential
respiratory arrest (when breathing stops completely), including:
existing illness (e.g., emphysema, asthma),
allergic reaction (causing swelling of the throat),
cardiac emergency,
drowning,
suffocation,
obstructed airway,
body positioning that restricts breathing (i.e., positional asphyxia),
drug overdose, or
hyperventilation.
Breathing Rate
Abnormally fast (i.e., hyperventilation) or slow
Sporadic or irregular breaths
Labored Breathing
Increased effort by the victim
Breathing appears shallow or very deep
Little or no air is felt at the nose or mouth
Uneven or little chest movement
Breathing Sounds
Wheezing, gurgling, deep snoring sounds
No breathing sounds
Coloring
In advanced stages, lips, nail bed, skin will appear blue-grey in color due to lack of
oxygen (i.e., cyanosis)
Mental Status
Anxious
Fearful
Panicky
38
Respiratory Emergencies, Continued
First aid measures
If a peace officer suspects that a victim is experiencing a respiratory emergency, the officer
should activate the EMS system (if not already activated) and take appropriate first aid
measures.
First Aid Measures for Respiratory Emergencies
Assessment - Conduct primary and secondary surveys. Check for breathing. Look for even
rise and fall of the victim’s chest. Listen for air entering and leaving the victim’s nose and
mouth. Feel for air moving into and out of the victim’s nose and mouth.
Treatment
Activate EMS system, if necessary.
Place the victim in a position of comfort (e.g., seated, supine, etc.).
If victim is unconscious, place in the recovery position, if appropriate.
Keep the victim calm and still.
Allow the victim to take prescribed medications (e.g., inhaler).
Loosen any restrictive clothing.
Provide care to prevent shock.
Maintain victim’s body temperature.
Continue to monitor victim’s CABs and provide reassurance.
Be prepared to begin rescue breathing if necessary.
39
Seizures
Introduction - A seizure is the result of a surge of energy through the brain. Instead of
discharging electrical energy in a controlled manner, the brain cells continue firing, causing
massive involuntary contractions of muscles and possible unconsciousness. If only part of the
brain is affected, it may cloud awareness, block normal communication, and produce a
variety of undirected, unorganized movements.
Epilepsy is a term for a convulsive disorder which causes brief, temporary changes in the
brain’s electrical system, known as a seizure.
Indicators of a seizure
Indicators of a seizure may include:
staring spells,
disorientation,
lethargy,
slurred speech,
staggering or impaired gait,
tic-like movements,
rhythmic movements of the head,
purposeless sounds and body movements,
dropping of the head,
lack of response,
eyes rolling upward,
lip smacking, chewing, or swallowing movements,
partial or complete loss of consciousness, or
picking at clothing
NOTE: Individuals with epilepsy may exhibit characteristics similar to the effects of drug use
or alcohol intoxication.
Actions
When officers encounter someone experiencing a seizure, the officers should:
look for medical alert bracelets, necklaces, or other terms of medical identification.
not restrain them.
move objects out of the way which could harm them.
cushion the person’s head.
keep people away.
turn the person on his/her side.
never put any object in the mouth.
After the seizure has ended, individuals may experience a period of post seizure confusion.
Officers should remain with the individual until the individual is reoriented to the
surroundings or in the care of a responsible person.
40
NOTE: Individuals with epilepsy often exhibit behavior similar to the effects of drug use or
alcohol intoxication.
NOTE: Convulsions, confusion, and episodes of agitated behavior during an episode should
not be perceived as deliberate hostility or resistance to the officer.
Seizures, Continued
Medications - Depriving medications could trigger a seizure. Officers should be guided by
agency policy regarding the administering of prescribed medications.
Examples The following examples illustrate officer interactions with people experiencing a
seizure.
Example: While on patrol, two officers were stopped by a man who stated that there was a
woman on the sidewalk who seemed to be “sick or something.” When the officers
approached, they saw the woman on the ground. She was unconscious and jerking back and
forth. One of the officers recognized that the woman was experiencing a seizure and told his
partner to keep everyone else away. After a couple of minutes the woman’s actions stopped.
When the woman regained consciousness, the officer approached her and reassured her that it
was all right. The woman appeared to be dazed and confused so the officers remained with
her until she was able to leave safely.
Example: An officer was called to a parking lot where a man appeared to be wandering about
in a daze. The man was staring straight ahead and seemed to be moving aimlessly, oblivious
of his surroundings. The man did not respond to the officer’s questions and instead continued
smacking his lips and picking at his shirt. When the officer attempted to take hold of the
man’s arm, the man began to struggle and became agitated. The officer failed to recognize
that the man was experiencing a partial seizure and assumed that he was under the influence
of drugs. The officer’s actions caused a potential for injury.
41
Strokes
Introduction A victim experiences a stroke (i.e., cerebrovascular accident (CVA)) when an
artery providing blood to the brain is blocked. A stroke can also be caused by a ruptured
blood vessel in the brain creating pressure on brain tissues.
Indicators of Stroke
Mental Status
Mobility
Convulsions
Vision
Communication
Other
First Aid Measures for Stroke
If a peace officer suspects that a victim has experienced a stroke, the following first aid
measures should be taken.
Assessment
Conduct primary and secondary surveys.
Activate the EMS system (if not already activated).
Treatment
If conscious, elevate head and shoulders slightly (semi-sitting position).
If unconscious, and appropriate, place in recovery position on affected side.
Activate the EMS system (if not already activated).
Continue to monitor CABs and maintain an open airway.
Reassure victim.
Take appropriate actions to prevent shock.
Protect any numb or paralyzed areas from possible injury.
Do not give victim anything by mouth.
Diabetic Emergencies
Introduction The basic source of energy within the human cell is glucose. Glucose is
circulated throughout the body in the bloodstream. In order for glucose to pass from the
bloodstream into the body’s cells, insulin, a hormone produced by the pancreas, must be
present. An imbalance of insulin in the body and glucose in the bloodstream can lead to life-
threatening conditions.
Diabetes is a condition brought on when the body does not produce a sufficient amount of
insulin. Diabetes can occur at any age.
Insulin shock and diabetic coma
An improper level of insulin in the body can lead to two potentially dangerous conditions:
insulin shock and diabetic coma.
42
Indicators There are a number of different indicators of a possible diabetic emergency.
The following table presents a comparison of the indicators of insulin shock and diabetic
coma:
Indicators of a Diabetic Emergency Insulin Shock Diabetic Coma Onset
Skin
Breathing
Mental Status
Pulse
Other
Diabetic Emergencies, Continued
Diabetic emergency vs. other conditions
There are a number of indicators of a diabetic emergency that are similar to indications of
alcohol intoxication or substance abuse.
Aggressiveness
Combativeness
Uncooperative behavior
Confusion, dazed appearance
Decreased level of consciousness
Impaired motor skills
Peace officers should never assume that a person exhibiting these indicators is intoxicated
without further questioning and assessment.
First Aid Measures for Diabetic Emergencies
Because it can be extremely dangerous and life-threatening if left untreated, a possible
diabetic emergency must be thoroughly assessed and first aid measures taken immediately.
Along with activating the EMS system (if not already activated) officers should take the
following first aid measures.
Assessment
Ask questions to determine if victim has exhibited any indications of a potential
diabetic emergency.
Look for medical alert jewelry or other indicators that the person may be diabetic (e.g.
wallet identification card, oral medications, insulin in the refrigerator, etc.).
Conduct primary and secondary surveys.
Treatment
If unconscious:
If conscious,
NOTE: Types of oral glucose include:
- table sugar (not a sugar substitute) dissolved in water.
- orange juice.
- honey.
- hard candy placed under the tongue.
43
Poisoning and Substance Abuse
Introduction A poison is any substance introduced to the body that causes damage.
Children are the most common victims of poisoning. Adults may become victims of poisons
from their environment as well as by overdoses of medications or substance abuse.
Poison identification
Peace officers acting as EMS First Responders should make every effort to obtain pertinent
information from the victim, family members, and bystanders as well as through their own
observations.
Officers should attempt to determine:
what substance or combination of substances is involved,
when was the victim exposed to the substance,
how much of the substance the victim was exposed to,
length of time the victim was exposed,
what effects the victim has experienced since the exposure, and
what if any interventions others (e.g., family members, friends, etc.) have already
taken.
Officers should also look for indications of:
medical problems (e.g., bottles of medications, medical alert jewelry, etc.),
existence of injuries, and/or
evidence of alcohol or illegal drug use (e.g., drug paraphernalia, bottles, etc.).
Officer safety
Peace officers responding to medical emergencies involving poisons should take appropriate
precautions against exposing themselves to the substance as well.
Officers should:
not enter any environment containing poisonous gases or fumes until the area has
been well ventilated.
use care when handling hypodermic needles or other sharp objects that may be
contaminated.
not take any actions that could cause them to become victim’s of the substance.
Manner of exposure
Poisons can be taken into the body in various ways, either accidentally or deliberately.
Ingestion - Swallowing the substance
Medications
Illegal drugs
Alcohol
Household or industrial chemicals
Petroleum products
Improperly prepared food
44
Poisoning and Substance Abuse, Continued
Inhalation - Breathing in the substance in the form of gases, vapors, or fine sprays
Carbon monoxide
Household or industrial chemicals
Petroleum products
Absorption - Taking in the substance through unbroken skin or membranes
Insecticides
Agricultural chemicals
Plant materials (e.g., poison ivy)
Injection - Through deliberate or accidental punctures to the skin
Illegal drugs
Medications
Indicators of Poisoning
Specific indicators will vary greatly depending on the poisonous substance involved. The
following table presents a number of indicators that may aid in determining the manner in
which the poison was taken into the body:
Ingestion
Possible burns around the mouth or hands
Unusual stains or colors on skin or mouth
Strong odor on victim’s breath
Difficulty breathing
Sudden unexplained, severe illness
Vomiting, abdominal cramping
Inhalation
Dizziness
Headache
Nausea, vomiting, abdominal cramping
Absorption
Itching
Redness, rash, or some other form of skin reaction
Increased skin temperature
Headache
Eye irritation
Allergic reaction
Injection
Swelling at injection site
Redness of affected skin
NOTE: Some individuals may have a systemic (i.e., whole body) reaction when exposed to
certain substances. One symptom of a systemic reaction is anaphylactic shock, a condition
that causes the airway to swell, making breathing difficult if not impossible.
45
Poisoning and Substance Abuse, Continued
First Aid Measures for Poisoning
Just as the indicators vary, first aid measures for treating a poisoning victim vary based on
the specific type of poison and how it was ingested. For serious medical emergencies, the
officer should activate the EMS system (if not already activated).
If a peace officer, acting as an EMS First Responder, suspects that a victim has been exposed
to a poison, that officer should take the following first aid measures:
Assessment
Determine the victim’s level of consciousness.
Conduct primary and secondary assessments. (Look for signs of swelling, redness,
puncture sites, etc.)
Attempt to identify the poisonous substance.
Treatment
Activate the EMS system.
If necessary, remove victim from source of poison (gases, vapors, plant material,
etc.).
If victim is unconscious, place in a recovery position, if appropriate.
Contact poison control center for treatment advice.
If exposure has been through absorption:
o flood affected areas with water, and
o wash affected areas with soap and water.
Take precautions to prevent shock.
Continue to monitor victim’s CABs.
Alcohol and substance abuse
There are a number of indicators specific to poisonings caused by alcohol and/or substance
abuse, of which officers should be aware. Indications of withdrawal from alcohol or drugs
can include, but are not limited to:
confusion,
hallucinations or psychotic behavior,
blackouts (i.e., loss of short term memory),
altered mental status,
tremors or shaking,
profuse sweating, or
increased pulse and breathing rates.
Certain types of drug abuse can also be associated with violent outbursts and aggressive
behavior. Officers should take necessary precautions to protect themselves and others when
assisting an individual suspected of drug or alcohol abuse.
46
Temperature Related Emergencies
Introduction The body must generate heat in order to maintain a constant internal body
temperature. Excess heat is released through the lungs and skin. If the body is not able to
generate enough heat or generates too much heat, the body’s systems may shut down,
creating a life-threatening condition.
Cold related emergencies
Hypothermia occurs when the body’s internal temperature drops to the point where body
systems are affected. Hypothermia can range from mild to severe due to a number of factors:
length of exposure to cold temperatures,
condition of victim’s clothing (wet or dry),
age of victim (elderly and very young are more susceptible),
existence of underlying illnesses or disorders (e.g., circulatory problems,
infections/fever),
traumatic injury (e.g., head injuries, etc.), or
alcohol consumption.
NOTE: Hypothermia can develop even in temperatures that are above freezing.
Indicators of Hypothermia
Mild/Moderate Hypothermia
Violent shivering
Numbness
Fatigue
Forgetfulness
Confusion
Cold skin
Red skin color
Loss of motor coordination
Rapid breathing and pulse
Severe Hypothermia
Lack of shivering
Rigid muscles and joints
Slow shallow breathing
Irregular, weak, slow pulse
Dilated pupils
Decreased level of consciousness leading to unconsciousness
Unwilling or unable to do simple activities
Not oriented to person, place, or time
Slurred speech
Blue-grey skin color
NOTE: Unconscious victims with hypothermia may appear clinically dead due to stiffness
and extremely low pulse and respiration rates.
47
Temperature Related Emergencies, Continued
First aid measures for hypothermia
First aid measures are dependent upon whether the victim’s condition is mild or severe.
First Aid Measures for Hypothermia Mild/ Moderate
Move victim to a warm environment (e.g., patrol vehicle).
Remove any wet clothing and replace with dry.
Rewarm victim slowly.
Provide care to prevent shock.
Monitor the victim’s CABs.
If victim can swallow easily, give warm liquids (e.g., water).
Do not give alcoholic or caffeinated beverages, or nicotine because they can further
hinder circulation.
Keep the victim moving to increase circulation.
Severe Hypothermia
Activate the EMS system (if not already activated).
Determine the victim’s level of consciousness.
Conduct primary and secondary surveys.
If victim has a pulse but is not breathing, begin rescue breathing.
If victim has no pulse and is not breathing, begin CPR.
NOTE: If the victim cannot be moved, take necessary measures to keep the victim from
losing more body heat (e.g., wrap in blankets, etc.).
Frostbite
Exposure to cold temperatures can also lead to cold-related injuries to parts of the body.
Injuries that are the result of cold or freezing tissue include frostnip and frostbite.
Areas most commonly affected by frostbite are:
ears,
face and nose,
hands,
feet and toes.
Indicators First Aid Measures
Frostnip
Superficial freezing of skin’s outer layer
Numbness
Pale skin color
Skin feels flexible to the touch
Tingling or burning sensation to the area upon warming
Temperature Related Emergencies, Continued
48
Indicators First Aid Measures
Frostbite
Freezing of tissue below the skin’s surface
Skin feels stiff to the touch
Pale, grey-yellow, grey-blue, waxy, blotchy skin color
Pain or aching sensation to the area upon warming
NOTE: Do not rub the affected area. Damage may be caused by ice crystals that have formed
below the surface of the skin.
NOTE: Do not allow the frozen area to refreeze after warming. Refreezing can cause
extensive tissue damage.
Heat cramps and heat exhaustion
If the body is unable to get rid of excess heat, the body’s internal temperature can rise to a
level that can cause pain, organ damage, or even death.
Heat cramps can strike when the body loses too much salt due to prolonged perspiration.
Heat exhaustion is a condition that is more serious than heat cramps. It is a form of shock
that can occur when the body becomes dehydrated. Once a person who is exposed to heat
becomes thirsty, that person may already be suffering from dehydration. In both cases, the
person will have a normal body temperature and be able to think clearly.
First aid measures for heat cramps and heat exhaustion
Heat cramps and heat exhaustion can be relatively minor illnesses if they are recognized and
treated rapidly. The following table identifies the indicators as well as first aid measures for
each:
Indicators First Aid Measures
Heat Cramps
Painful muscle spasms usually in the legs or abdomen
Lightheadedness
Weakness
Temperature Related Emergencies, Continued
Heat Exhaustion
Profuse sweating
Dizziness
Headache
Pale, clammy skin
Rapid pulse
Weakness
Nausea and vomiting
Heat stroke
49
If heat exhaustion is not recognized and treated promptly, heat stroke may set in. Heat
stroke occurs when the body’s internal temperature rises abnormally high. Heat stroke is a
life-threatening condition requiring immediate attention.
Indicators / First Aid Measures
Heat Stroke
Red, hot, dry skin
Rapid, irregular pulse
Shallow breathing
Confusion
Weakness
Possible seizures and/or unconsciousness
NOTE: Heat stroke can affect children or the elderly who have circulatory problems, even
when they are not exposed to extreme heat.
NOTE: Dry hot conditions, versus heat with high humidity, can bring on less fatigue. For this
reason, individuals may remain in a dry hot environment longer and become more
susceptible to heat related illnesses.
Stings and Bites
Introduction - Insect stings, spider bites, and snake bites can all be sources of injected toxins.
Certain insects, spiders, and snakes can inject toxins that cause serious consequences if not
treated rapidly.
Anaphylactic shock
Anaphylaxis (i.e., anaphylactic shock) is a severe, life-threatening allergic reaction caused
by exposure to certain allergens. Exposure to an allergen (via insect stings, foods, etc.) can
cause:
blood vessels to dilate leading to a sudden drop in blood pressure, and
swelling of the tissues that line the respiratory system causing an obstructed airway.
First aid measures
Epinephrine - is a hormone produced by the body. When administered as a medication soon
after exposure, epinephrine will constrict blood vessels and dilate the bronchioles helping to
open the victim’s airway. Individuals who are subject to anaphylaxis often carry prescription
epinephrine to use if such a reaction occurs.
Insect stings and bites
50
Insects that sting include wasps, hornets, bees, yellow jackets, and fire ants. Insects that bite
include mosquitoes, lice, gnats, and ticks. In either case, most insect stings and bites are little
more than an irritation to the victim; unless they produce a venom which induces
anaphylaxis.
Indicators First Aid Measures
Usual Reaction
Local swelling
Minor pain
Itching
Allergic Reaction
Itching
Burning sensation
Hives
Swollen lips and tongue
Difficulty breathing
Respiratory failure
Stings and Bites, Continued
Spider bites
Although most spiders are harmless, the venom from the Black Widow and Brown Recluse
spiders can cause serious illness. The following table provides information regarding first aid
measures for treating the victim or bites from these spiders:
Description Indicators / First Aid Measures
Black Widow - Marked by a real, hourglass shaped spot on its abdomen.
Dull pain within 15 minutes of bite
Headache
Chills
Sweating
Dizziness
Nausea and vomiting
Brown Recluse - Marked by a brown or purplish violin-shaped mark on its back
Painless ulcer at site where bitten
Ulcer gradually increases in size (bull’s-eye appearance)
Chills
Aches
Nausea
Snake bites - Most native snakes in California are not poisonous. The exceptions are the
Rattlesnake and poisonous snakes that have been brought into the state. Bites from poisonous
snakes can be extremely serious but rarely fatal.
Indicators / First Aid Measures
Pain, redness, and swelling which begins quickly after bite
Fang marks
Shortness of breath
51
Tingling around victim’s mouth
Bloody vomiting (appearance of coffee grounds)
Shock
Coma
Stings and Bites, Continued
Animal and human bites
Although animal and human bites do not involve toxins or venom, they can become infected
if not treated properly. The victim of an animal bite may also be at risk of rabies if the bite as
caused by an infected animal.
Indicators / First Aid Measures
Pain, redness, swelling at the site
Damage can range from puncture wound of skin to severe laceration or avulsion of
tissue.
NOTE: If possible, an attempt should be made to identify the circumstances that led to the
bite and locate the animal for rabies testing.
52
Childbirth
Officers must have a basic understanding of first aid measures to assist before, during, and
after delivery in an emergency situation. This chapter will focus on basic first aid measures
for assisting a woman during childbirth.
Normal Labor and Childbirth
Introduction - Only the woman herself can deliver her infant. If called upon to assist during
normal childbirth, it is the officer’s role to activate the EMS system, determine if the woman
can be transported prior to the birth, and provide support as the woman delivers the infant.
Transport prior to birth
One of the first decisions the assisting officer will need to make is whether or not to arrange
for transport to a medical facility prior to delivery of the infant. The woman can be safely
transported only if she is in the first stage of labor (not straining, contractions are still farther
apart, and there are no signs of crowning).
NOTE: If transport is safe, continue to monitor the woman while waiting for EMTs to arrive
at the scene.
Imminent birth
If any of the following conditions exist, the woman is entering the second stage of labor and
birth may be imminent. The woman should not be transported.
Indications that birth may be imminent include:
contractions that are occurring less than two minutes apart (five minutes if second or
subsequent birth),
the woman feels an urgent need to bear down, and/or
crowning is present.
Complications in Childbirth
Introduction - Although most deliveries take place without difficulty, complications may
occur. At such times, it is extremely important to activate the EMS system, provide
emotional support and reassurance to the woman and take appropriate first aid measures until
additional EMS personnel arrive at the scene.
Excessive bleeding prior to delivery
The presence of some blood prior to the beginning of delivery is normal. If bleeding is
excessive, it may be an indication of a complication. There are a number of possible causes
for this condition.
53
Complications in Childbirth, Continued
Indicators / First Aid Measures
Profuse bleeding from vagina
Mother may or may not experience abdominal pain.
Newborn fails to breathe
A newborn should begin breathing on its own within 30 seconds after birth. If it fails to
breathe, rubbing the infant’s back or tapping the infant’s feet may stimulate spontaneous
respiration. If the newborn still fails to breathe on its own, rapid first aid measures are
required. The following actions should be taken:
First Aid Measures
Circulation - Check for a brachial pulse; If there is no pulse, begin CPR immediately.
If there is a pulse, then check the airway.
Airway - Open the infant’s airway; do not overextend the head and neck. This could
close the airway or damage the infant’s trachea.
Breathing – Check for breathing looking and listening for breathing; if none, provide
two slow small breaths (“puffs”).
NOTE: For additional information regarding infant rescue breathing and CPR, refer to Basic
Life Support.
Glossary
54
Abdominal thrust - A technique used to force air out of the lungs, expelling obstructions from
a victim’s airway
Abrasion - An open wound characterized by a scraping away of only the outer portion of the
skin
Airborne pathogen - A pathogen that is spread by tiny droplets sprayed during breathing,
coughing, or sneezing
Airway - The passageway by which air enters and leaves the lungs
Amputation - An open wound characterized by a surgical or traumatic removal of a body
extremity
Anaphylaxis (anaphylactic shock) - A severe life-threatening allergic reaction caused by
exposure to certain allergens
Automated external defibrillator (AED) - An external defibrillator capable of cardiac rhythm
analysis which can deliver a electric shock to a cardiac arrest victim
Avulsion - An open wound characterized by a part or structure of the body being forcibly torn
or cut away
Bacteria - Microscopic organisms that can live in water, soil, or organic material, or within
the bodies of plants, animals, and humans
Bandage - Any material used to hold a dressing in place
Biological death - The point when breathing and circulation stop, brain cells die due to lack of
oxygen, and vital organs begin to deteriorate
Blood borne pathogen - A pathogen that is spread when the blood or other body fluids (e.g.,
semen, phlegm, mucus membranes, etc.) of one person come into contact with an open
wound or sore of another
Bone - Hard yet flexible tissue that provides support for the body as well as protection for
vital organs
Brachial artery - Artery located on the inside of the upper arm, between the biceps and
triceps
Cardiac arrest - A state when a victim is unresponsive, not breathing, and has no carotid
pulse to indicate circulation
Cardiopulmonary resuscitation (CPR) - A method of artificially restoring and maintaining a
victim’s breathing and circulation
Carotid artery - Large artery found on each side of the neck which carries blood to the head
Carotid pulse - The most reliable indication that the victim’s heart is functioning and to
determine the severity of the victim’s condition during the CAB assessment process; felt on
either side of the neck
Cartilage - Connective tissue that covers the outside of the end of bones; helps for certain
flexible structures of the body and allows for smooth movement of bones at joints
Chemical burn - Burn caused by acids or alkalis coming into contact with the skin
Chest thrust - A maneuver used to force obstructions from a victim’s airway; used instead of
abdominal thrusts when the victim has abdominal injuries, is in late stages of pregnancy, is
too obese for abdominal thrusts to be effective, or is an infant
Clinical death - The moment breathing and circulation stop, reversible condition if basic life
support is begun immediately
Closed fracture - Broken bone where there is no break in the skin at the site of the fracture
55
Complete airway obstruction - When a victim is unconscious and unable to breath after the
airway has been opened and a finger sweep performed, or conscious but unable to speak,
cough, or breathe
Convulsion - Violent uncontrolled muscle contractions
Coronary artery disease (CAD) - A disease caused when fatty deposits build up in the walls of
the arteries that feed the heart muscle (often referred to as coronary heart disease)
Dermis - Second layer of the skin containing nerves, hair follicles, and sweat glands
Diabetes - A condition brought on when the body does not produce a sufficient amount of
insulin
Diabetic coma - Overly high levels of glucose in the bloodstream (i.e., hyperglycemia)
Dislocation - When a bone is pushed/pulled out of alignment from a joint
Dressing - Any material applied to a wound to control bleeding and prevent contamination
Electrical burn - Burn that occurs when the body becomes a conduit for electrical current
Emergency rescue personnel - Any person who is a peace officer, employee or member of a
fire department, fire protection, or firefighting agency of the federal, state, city, or county
government
Emergency medical services - First aid and medical services, rescue procedures and
transportation, or other related activities necessary to ensure the health or safety of a person
in imminent peril
Epidermis - Outer-most layer of the skin
Epilepsy - A medical condition characterized by seizures that recur without apparent reason
Epinephrine - A hormone produced by the body; when administered as a medication, it will
constrict blood vessels and dilate the bronchioles helping to open a victim’s airway
Fainting - A form of shock characterized by sudden unconsciousness
Finger sweep - Opening the victim’s mouth by grasping both the tongue and lower jaw in
hand then inserting the index finger along the victims cheek then the throat to hook the object
First-degree burn - Damage only to the epidermis
Flail chest A condition where the ribs and/or sternum is fractured and a segment of the
chest wall does not move
Fourth-degree burn - Damage to epidermis, dermis, fatty layer, muscle, bone, and underlying
organs
Fracture - Complete or partial break of a bone
Frostbite - Freezing of tissue below the skin surface
Frostnip - Superficial freezing of outer layer of skin
Gastric distention - When air is forced into the victim’s stomach as well as lungs, causing the
stomach to become distended; can happen during rescue breathing maneuver glucose, t he
basic source of energy within the human cell
Head-tilt/chin-lift - Technique used to open a victim’s airway when there are no indications of
head, neck, or spinal injury
Heart attack - When the heart muscle goes into distress due to lack of oxygenated blood. If
the heart is sufficiently damaged, cardiac arrest will result. The greatest risk of death from
heart attack is within 2 hours after the onset of symptoms
Heat cramps - A condition caused when the body loses too much salt due to prolonged
perspiration
Heat exhaustion - A form of shock that can occur when the body becomes dehydrated; more
serious than heat cramps
56
Heat stroke - A life-threatening condition which occurs when the body’s internal temperature
rises abnormally high
Hyperventilation - Abnormally rapid breathing
Hypothermia - When the body’s internal temperature drops to the point where body systems
are affected
Implied consent - The legal position that assumes that an unconscious, confused, or seriously
ill victim would consent to receiving emergency medical services if that person were able to
do so
Incision - An open wound characterized by a smooth, straight cut caused by a sharp object
Insulin - A hormone produced by the pancreas that must be present in the body in order for
glucose to pass from the bloodstream into the body’s cells
Insulin shock - Overly low levels of glucose in the bloodstream; hypoglycemia
Jaw-thrust - Technique used to open a victim’s airway when there are indications of head,
neck, or spinal injury
Joint - Location where bones fit together; allows for body movement
Laceration - An open wound characterized by a jagged-edged wound caused by objects
tearing or ripping the skin
Ligament - Connective tissue that attaches to the end of bones and supports joints; allows for
a stable range of motion
Occlusive dressing - A nonporous dressing used to cover a wound and create an air-tight seal
Open fracture - Broken bone where there is a break in the skin at the site of the fracture
Open wound - Any injury where the skin has been broken, exposing the tissue underneath
Paradoxical breathing - When both sides of the chest do not move in a synchronized manner
Pathogens - Agents that are spread through the air or by contact with another person’s blood
or body fluids that cause infection and disease
Partial airway obstruction - When the victim indicates an airway problem (i.e., choking) but
is able to speak or cough
Penetrating puncture - Open wound with only an entrance wound; can be shallow or deep
Perforating puncture - Open wound with an entrance wound and an exit wound
Perfusion - The continued flow of blood through the capillaries supplying the tissues and
organs of the body with oxygen and removing waste products
Poison - Any substance introduced to the body that causes damage
Prone - face down
Pulse - A pulse, measured in beats per minute, is an indication of the rate of blood flow
through the body.
Puncture - An open wound characterized by a deep wound through the skin and other tissue
Primary survey - A rapid systematic process for detecting life-threatening medical conditions;
includes assessment for responsiveness, airway, breathing, circulation, control of major
bleeding, and treatment for shock
Recovery position - On the victim’s side with the head supported by the lower forearm
Rescue breathing - The process of using one’s own breaths to artificially breathe for a victim
Respiration rate - The number of breathing cycles (inhaling and exhaling) per minute
Respiratory arrest - Complete cessation of breathing
Respiratory failure - The inability to intake oxygen, to the point where life cannot be
sustained
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Secondary survey - A systematic examination of a victim to determine whether serious
conditions exist; includes gathering information, conducting heat-to-toe check for injuries,
and checking vital signs
Second-degree burn - Damage to the epidermis and dermis
Seizure - The result of a surge of energy through the brain. Instead of discharging electrical
energy in a controlled manner, the brain cells continue firing, bringing on sudden changes in
sensation, behavior, or movement
Shock - A life-threatening condition caused by inadequate perfusion
Skeletal muscle - Soft fibrous tissue that controls movement of bones and joints
Sprain - Severely stretched or torn ligament
Strain - Over-stretched or torn muscle
Stroke - When an artery providing blood to the brain is blocked and the tissues of that part of
the brain do not receive adequate amounts of oxygen; can also be caused by a ruptured blood
vessel in the brain creating pressure to brain tissues
Supine - On the victim’s back (face up)
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