CHAP TE R 1 - Mr. Rienas

CHAP TE R 1 - Mr. Rienas
victim, you must follow a series of general procedures
designed to ensure a proper assessment and response.
These include activating the emergency action plan (EAP), sizing
up the scene, performing a primary assessment and summoning
emergency medical services (EMS) personnel for any life-threatening
emergencies. If you do not find a life-threatening situation, you should
perform a secondary assessment and provide first aid as needed.
This chapter covers how to perform a
secondary assessment, including
how to check a conscious victim
and how to take a brief history.
It also describes how to
recognize and provide
first aid for some of the
injuries, illnesses and
medical conditions that
you might encounter
while on the job. Q
10
A
s covered in Chapter 7, when you encounter an ill or injured
CHAPTER
First Aid
CHAPTER 10 FIRST AID
RESPONDING TO INJURIES AND ILLNESSES
Even when everyone works to prevent emergencies, injuries and
illnesses do occur at aquatic facilities. With some injuries, such
as a nosebleed, the problem will be obvious and easy to treat
by following the first aid care steps described in this chapter. In
other situations, such as a sudden illness, it may be harder to
determine what is wrong.
Figure 10-1
In all cases, remember to follow the general procedures for
injury or sudden illness on land and to use appropriate personal
protective equipment, such as disposable gloves and CPR
breathing barriers. It is a common practice to carry a few first aid
supplies in your hip pack (Figure 10-1).
Also, be aware that every facility should have a first aid area
where an injured or ill person can receive first aid and rest,
and where first aid supplies are available (Figure 10-2). Some
facilities staff the first aid area with highly trained personnel,
such as emergency medical technicians (EMTs). You should
know where your facility’s first aid area is located, the type
of equipment and supplies available, how to provide first
aid correctly and whether staff with more advanced training
are present.
A few first aid supplies can be carried in
your hip pack
Figure 10-2
Considerations for
Responding to Injuries
and Illnesses
Your job as a lifeguard requires you to juggle
many responsibilities. Injuries happen suddenly,
and in a first aid emergency you must decide
how best to respond to the situation, including
when to activate the EAP. The ability to
recognize that an emergency has occurred is
the first step toward taking appropriate action.
Once you recognize that an emergency has
occurred, you must decide to act. To help make
decisions in an emergency situation, consider
the following:
Q
Q
Q
Q
Q
Q
Every facility should have first aid supplies that are available
from a first aid area.
Should I provide care where the victim was found, or move him or her to the
first aid room?
Is the safety of the victim or others compromised?
Is there a risk of further injury to the victim?
Is there a risk of exposing the victim or others to pathogens (e.g., by leaving
a trail of blood or body fluids)?
Should I summon EMS personnel?
When should I recommend that the victim see a health care provider to seek
further medical treatment?
215
216
LIFEGUARDING MANUAL
Figure 10-3
SECONDARY
ASSESSMENT
During the secondary assessment, you should take
a brief history and perform a quick head-to-toe
physical exam (Figure 10-3). If any life-threatening
conditions develop during your secondary
assessment, stop the assessment and provide
appropriate care immediately.
When conducting a secondary assessment on a conscious
victim, perform a head-to-toe physical exam.
Using SAMPLE to Take
a Brief History
Use the SAMPLE mnemonic as an easy way to remember what you should ask
about when you are taking the brief history:
S = Signs and symptoms
c
These include bleeding, skin that is cool and moist, pain, nausea, headache
and difficulty breathing.
A = Allergies
c
Determine if the victim is allergic to any medications, food, or environmental
elements, such as pollen or bees.
M = Medications
c
Find out if the victim is using any prescription or nonprescription
medications.
P = Pertinent past medical history
c
Determine if the victim is under the care of a health care provider for any
medical condition, has had medical problems in the past or recently has
been hospitalized.
L = Last oral intake
c
Find out what the victim most recently took in by mouth as well as the
volume or dose consumed. This includes food, drinks and medication.
E = Events leading up to the incident
c
Determine what the victim was doing before and at the time of the incident.
When talking to a child, get down at eye level with the child, speak slowly and in a
friendly manner, use simple words and ask questions that the child can easily understand.
Checking a Conscious Person
Check the victim by performing a head-to-toe exam. Before beginning the exam, tell the
person what you are going to do. Visually inspect the person’s body, looking carefully
for any bleeding, cuts, bruises and obvious deformities. Look for a medical identification
(ID) tag, necklace or bracelet on the person’s wrist, neck or ankle (Figure 10-4). These
will provide medical information about the person, explain how to care for the conditions
identified and list whom to call for help. Do not ask the person to move any areas in
CHAPTER 10 FIRST AID
which he or she has discomfort or pain or if a head, neck or
spinal injury is suspected.
Figure 10-4
When checking a child or infant for non-life-threatening
conditions, observe the child or infant before touching him or her.
Look for signs and symptoms that indicate changes in the level
of consciousness (LOC), trouble breathing and any apparent
injuries or conditions. If a child or an infant becomes extremely
upset, conduct the check from toe to head. This will allow the
child or infant to become familiar with the process and see what
is happening. Check for the same things on a child or an infant
that you would look for with an adult.
See the Checking a Conscious Person skill sheet at the end of this
chapter for steps to follow when performing a head-to-toe exam.
If the person is unable to move a body part or is experiencing
dizziness or pain on movement:
Q
Q
Q
Q
Q
Help the person rest in a comfortable position.
Keep the person from getting chilled or overheated.
Reassure the person.
Determine whether to summon EMS personnel.
Continue to watch for changes in LOC and breathing.
Medical ID tags, necklaces and bracelets can
provide important information about an injured
or ill person.
SUDDEN ILLNESS
Sudden illness can happen to anyone, anywhere. You may not be able to identify the
illness, but you still can provide care. Victims of sudden illness usually look and feel
ill. If you suspect something is wrong, check the victim and look for a medical ID tag,
necklace or bracelet on the person’s wrist, neck or ankle. The victim may try to say
nothing is seriously wrong, but the victim’s condition can worsen rapidly. Do not be
afraid to ask the victim questions.
There are many types of sudden illness, including diabetic emergencies, fainting,
seizures and stroke.
Signs and Symptoms of Sudden Illness
Many sudden illnesses have similar signs and symptoms. These include:
Q
Q
Q
Q
Q
Q
Changes in LOC, such as feeling
light-headed, dizzy or becoming
unconscious.
Nausea or vomiting.
Difficulty speaking or slurred speech.
Numbness or weakness.
Loss of vision or blurred vision.
Changes in breathing; the person
may have trouble breathing or may
not be breathing normally.
Q
Q
Q
Q
Q
Q
Q
Changes in skin color
(pale, ashen or flushed skin).
Sweating.
Persistent pressure or pain.
Diarrhea.
Seizures.
Paralysis or an inability to move.
Severe headache.
217
218
LIFEGUARDING MANUAL
General Care Steps for Sudden Illness
When providing care for sudden illness, follow the general procedures for injury
or sudden illness on land:
Q
Q
Q
Q
Q
Care for any life-threatening conditions first.
Monitor the victim’s condition and watch for changes in LOC.
Keep the victim comfortable, reassure him or her and keep the victim from
getting chilled or overheated.
Do not give the victim anything to eat or drink unless the victim is fully conscious
and is not in shock.
Care for any other problems that develop, such as vomiting.
Diabetic Emergencies
People who are diabetic sometimes become ill because there is too much or
too little sugar in their blood. Many people who are diabetic use diet, exercise or
medication to control their diabetes. The person may disclose that he or she is
diabetic or you may learn this from the information on a medical ID tag or from
a bystander. Often, people who have diabetes know what is wrong and will ask
for something with sugar if they are experiencing symptoms of low blood sugar
(hypoglycemia). They may carry some form of sugar with them.
If the person is conscious and can safely swallow fluids or food, give him or her
sugar. If it is available, give glucose paste or tablets to the victim. If not available,
sugar in liquid form is preferred. Most fruit juices (e.g., about 12 ounces of orange
juice), milk and non-diet soft drinks have enough sugar to be effective (Figure
10-5). You also can give table sugar dissolved in a glass of water. If the person
has hypoglycemia, sugar will help quickly. If the problem is high blood sugar
(hyperglycemia), giving the sugar will not cause any further harm. Give something
by mouth only if the victim is fully conscious.
Always summon EMS personnel for any of the following circumstances:
Q
Q
Q
Q
The person is unconscious or about to lose consciousness.
The person is conscious and unable to swallow.
The person does not feel better within about 5 minutes after taking sugar.
A form of sugar cannot be found immediately. Do not spend time looking for it.
Figure 10-5
Fainting
Give a victim experiencing a diabetic emergency fruit juice,
milk or a non-diet soft drink.
When a person suddenly loses consciousness
and then reawakens, he or she may simply
have fainted. Fainting is not usually harmful,
and the person will usually quickly recover.
Lower the person to the ground or other flat
surface and position the person on his or her
back. Loosen any tight clothing, such as a tie
or collar. Make sure the victim is breathing.
Do not give the victim anything to eat or drink.
If the victim vomits, position the victim on his
or her side.
CHAPTER 10 FIRST AID
Seizures
There are many different types of seizures. Generalized seizures usually last 1 to
3 minutes and can produce a wide range of signs and symptoms. When this type
of seizure occurs, the person loses consciousness and can fall, causing injury. The
person may become rigid and then experience sudden, uncontrollable muscular
convulsions, lasting several minutes. Breathing may become irregular and even
stop temporarily.
Seeing someone have a seizure may be intimidating, but you can provide
care for the person. The person cannot control any muscular convulsions that
may occur, and it is important to allow the seizure to run its course because
attempting to restrain the person can cause further injury. To provide care to a
person having a seizure:
Q
Q
Protect the person from injury by moving nearby objects away from the person.
Position the person on his or her side, if possible, after the seizure passes so
that fluids (saliva, blood, vomit) can drain from the mouth.
When the seizure is over, the person usually begins to breathe normally. He or she
may be drowsy and disoriented or unresponsive for a period of time. Check to see if
the person was injured during the seizure. Be reassuring and comforting. If the seizure
occurred in public, the person may be embarrassed and self-conscious. Ask bystanders
not to crowd around the person. He or she will be tired and want to rest. Stay with the
person until he or she is fully conscious and aware of his or her surroundings.
If the person is known to have periodic seizures,
there is no need to summon EMS personnel. He
or she usually will recover from a seizure in a few
minutes. However, summon EMS personnel if:
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
The seizure occurs in the water.
The seizure lasts more than 5 minutes.
The person has repeated seizures with no sign
of slowing down.
The person appears to be injured.
The cause of the seizure is unknown.
The person is pregnant.
The person is known to have diabetes.
The person fails to regain consciousness after
the seizure.
The person is elderly and may have suffered
a stroke.
This is the person’s first seizure.
Figure 10-6
Figure 10-7
Seizures in the Water
If a person has a seizure in the water:
1. Summon EMS personnel.
2. Support the person with his or her
head above water until the seizure ends
(Figures 10-6 and 10-7).
If someone experiences a seizure while in the water, support
the victim’s head above the water until the seizure ends.
219
220
LIFEGUARDING MANUAL
3. Remove the person from the water as soon as possible after the seizure (since
he or she may have inhaled or swallowed water).
4. Once on land, position the person on his or her back and perform a primary
assessment. Give ventilations or CPR if needed. If the person vomits, turn the
victim on his or her side to drain fluids from the mouth. Sweep out the mouth (or
suction out the mouth if you are trained to do so).
Stroke
Figure 10-8
As with other sudden illnesses, the signs and symptoms of a stroke or mini-stroke
are a sudden change in how the body is working or feeling. This may include sudden
weakness or numbness of the face, an arm or a leg. Usually, weakness or numbness
occurs only on one side of the body. Other signs
and symptoms include difficulty with speech
(trouble speaking and being understood, and
difficulty understanding others); blurred or dimmed
vision; sudden, severe headache; dizziness or
confusion; loss of balance or coordination; trouble
walking; and ringing in the ears.
If the person shows any signs or symptoms of
stroke, time is critical. The objective is to recognize
a possible stroke and summon EMS personnel
immediately. To identify and care for a victim of
stroke, think FAST:
Face—Weakness on one side of the face
(Figure 10-8)
c Ask the person to smile. This will show
Figure 10-9
if there is drooping or weakness in the
muscles on one side of the face. Does one
side of the face droop?
Q Arm—Weakness or numbness in one arm
(Figure 10-9)
c Ask the person to raise both arms to find
out if there is weakness in the limbs. Does
one arm drift downward?
Q Speech—Slurred speech or trouble speaking
c Ask the person to speak a simple sentence
to listen for slurred or distorted speech.
Weakness on one side of the body is another signal of a stroke.
Example: “The sky is blue.” Can the victim
repeat the sentence correctly?
Q Time—Time to summon EMS personnel if any of these signs or symptoms are seen
c Note the time of onset of signs and symptoms, and summon EMS
personnel immediately.
Signals of a stroke include facial drooping.
Q
SKIN AND SOFT TISSUE INJURIES
Soft tissues are the layers of skin and the fat and muscle beneath the skin’s outer
layer. A physical injury to the body’s soft tissue is called a wound. Any time the soft
tissues are damaged or torn, the body is threatened. Injuries may damage the soft
CHAPTER 10 FIRST AID
tissues at or near the skin’s surface or deep in the body. Germs can enter the body
through a scrape, cut, puncture or burn and cause infection. Severe bleeding can
occur at or under the skin’s surface, where it is harder to detect.
Burns are a special kind of soft tissue injury. Like other types of soft tissue injury,
burns can damage the top layer of skin or the skin and the layers of fat, muscle and
bone beneath.
Soft tissue injuries typically are classified as either closed or open wounds.
Closed Wounds
Closed wounds occur beneath the surface of the skin. The simplest closed wound
is a bruise or contusion. Bruises result when the body is subjected to blunt force,
such as when you bump your leg on a table or chair. Such a blow usually results in
damage to soft tissue layers and blood vessels beneath the skin, causing internal
bleeding. Most closed wounds do not require special medical care. However, a
significant violent force can cause injuries involving larger blood vessels and the
deeper layers of muscle tissue. These injuries can result in severe bleeding beneath
the skin. In these cases, medical care is needed quickly.
Caring for Internal Bleeding
Summon EMS personnel immediately if:
Q
Q
Q
Q
Q
Q
Q
Q
The victim complains of severe pain or cannot move a body part without pain.
The force that caused the injury was great enough to cause serious damage.
An injured arm or leg is blue or extremely pale.
The victim has excessive thirst, becomes confused, faint, drowsy or
unconscious.
The victim is vomiting blood or coughing up blood.
The victim has skin that feels cool or moist, or looks pale or bluish.
The victim has a rapid, weak pulse.
The victim has tender, swollen, bruised or hard areas of the body, such as the
abdomen.
While waiting for EMS personnel to arrive, the objectives are to:
Q
Q
Q
Q
Q
Care for any life-threatening conditions first.
Help the victim rest in a comfortable position and reassure him or her.
Monitor the victim’s condition and watch for any changes in LOC.
Keep the victim from getting chilled or overheated (care for shock).
Care for other problems that develop, such as vomiting.
If the closed wound is not serious:
1. Apply direct pressure on the area to decrease bleeding under the skin.
2. Elevate the injured part to reduce swelling if you do not suspect a muscle, bone
or joint injury and if doing so does not cause more pain.
3. Apply ice or a cold pack on the area to help control swelling and pain.
c When applying ice or a chemical cold pack, place a gauze pad, towel or
other cloth between the source of cold and the victim’s skin.
221
222
LIFEGUARDING MANUAL
c
c
If an ice pack is not available, fill a plastic bag with ice and water or wrap ice
with a damp cloth.
Apply the ice or cold pack for no more than 20 minutes. If continued icing is
needed, remove the pack for 20 minutes and re-chill it, then replace it.
Open Wounds
Figure 10-10
In an open wound, the break in the skin can be as minor as a scrape of the surface layers
(abrasion) or as severe as a deep penetration. The amount of external bleeding depends
on the location and severity of the injury. Most external
bleeding injuries that you encounter will be minor,
such as a small cut that can be cared for by cleaning
the wound and applying an adhesive bandage. Minor
bleeding, such as results from a small cut, usually
stops by itself within 10 minutes when the blood clots.
However, some cuts are too large or the blood is
under too much pressure for effective clotting to
occur. In these cases, you need to recognize the
situation and provide care quickly. Remember to
always wear non-latex disposable gloves and follow
all other standard precautions when giving care.
Abrasion
The following are the four main types of open wounds:
Q
Figure 10-11
Q
Laceration
Q
Figure 10-12
Q
Avulsion
Abrasion (Figure 10-10)
c Skin has been rubbed or scraped away
(e.g., scrape, road rash, rug burn). The area
usually is painful.
c Dirt and other matter may have entered the
wound. Cleaning the wound is important to
prevent infection.
Laceration (Figure 10-11)
c Cuts bleed freely, and deep cuts can
bleed severely.
c Deep cuts can damage nerves, large blood
vessels and other soft tissues.
Avulsion (Figure 10-12)
c An avulsion is a cut in which a piece of soft
tissue or even part of the body, such as a
finger, is torn loose or is torn off entirely
(e.g., amputation).
c Often, deeper tissues are damaged,
causing significant bleeding.
Puncture (Figure 10-13)
c Puncture wounds often do not bleed
profusely and can easily become infected.
c Bleeding can be severe, with damage to
major blood vessels or internal organs.
c An object embedded in the wound should
be removed only by EMS personnel.
CHAPTER 10 FIRST AID
Caring for External Bleeding
Figure 10-13
To care for a minor wound, such as an abrasion,
follow these general guidelines:
Q
Q
Q
Q
Q
Q
Control any bleeding.
c Place a sterile dressing over the wound.
c Apply direct pressure until bleeding stops
(Figure 10-14, A).
Clean the wound thoroughly with soap (if
available) and water. If possible, irrigate an
abrasion with clean, warm running tap water for
about 5 minutes to remove any dirt and debris.
Puncture
If bleeding continues, use a new sterile
dressing and apply more pressure.
After bleeding stops, remove the dressing and apply antibiotic ointment, if one
is available, the victim has no known allergies or sensitivities to the medication
and local protocols allow you to do so.
Cover the wound with a sterile dressing and
Figure 10-14, A
bandage (or with an adhesive bandage) to
keep the wound moist and prevent drying.
(Figure 10-14, B).
Wash your hands immediately after
providing care.
To care for a major wound:
Q
Q
Q
Q
Q
Q
Activate the EAP, summon EMS personnel
and follow the general procedures for injury or
sudden illness on land.
Cover the wound with a sterile gauze dressing
and apply direct pressure using the flat part of
your fingers. A large wound may require more
pressure; use pressure from your full hand with
gauze dressings to try to stop the bleeding. For
an open fracture, do not apply direct pressure
over the broken bones, but instead pack sterile
gauze around the area to control bleeding and
prevent infection.
If the dressing becomes saturated with blood
while you are applying pressure, do not remove
it. Instead, place additional dressings over the
soaked bandage and reapply direct pressure.
Then cover the dressings with a bandage to
hold them in place.
Keep the victim warm and position the victim
on his or her back.
Care for other conditions, including shock.
Wash your hands immediately after providing care.
Apply direct pressure firmly against a wound for a few
minutes to control any bleeding.
Figure 10-14, B
Use a sterile dressing and bandage to cover the wound.
If conscious and able, the victim may use his or her hand to apply pressure while
you put your gloves on and prepare the necessary supplies.
223
224
LIFEGUARDING MANUAL
Shock
Any serious injury or illness can result in a condition known as shock. Shock is a
natural reaction by the body. It usually means the victim’s condition is serious. Signs
and symptoms of shock include restlessness or irritability; altered LOC; pale or ashen,
cool, moist skin; nausea or vomiting; rapid breathing and pulse; and excessive thirst.
To minimize the effects of shock:
Q
Q
Q
Q
Q
Q
Q
Q
Make sure that EMS personnel have been summoned.
Monitor the victim’s condition and watch for changes in LOC.
Control any external bleeding.
Keep the victim from getting chilled or overheated.
Have the victim lie flat on his or her back.
Cover the victim with a blanket to prevent loss of body heat. Do not overheat the
victim—your goal is to maintain a normal body temperature.
Comfort and reassure the victim until EMS personnel take over.
Administer emergency oxygen, if available and trained to do so.
Note: Do not give food or drink to a victim of shock, even if the victim asks for them.
Care for Wounds—Specific Situations
Patrons at aquatic facilities can suffer a variety of wounds, from a minor nosebleed to
a severed body part. No matter how seriously the victim is wounded, you must remain
calm and follow the general procedures for injury or sudden illness on land. This section
covers how to care for some of the specific wounds that you might encounter on the job.
Nosebleeds
To care for a nosebleed:
Q
Have the victim sit leaning slightly forward to prevent swallowing or choking on
the blood (Figure 10-15).
Pinch the nostrils together for about 5 to
10 minutes or until the bleeding stops.
c Other methods of controlling bleeding
include applying an ice pack to the bridge
of the nose or putting pressure on the
upper lip just beneath the nose.
c Do not pack the victim’s nose to stop
the bleeding.
Q After the bleeding stops, have the victim avoid
rubbing, blowing or picking the nose, which
could restart the bleeding.
Q Medical attention is needed if the bleeding
Control a nosebleed by having the victim sit with the head
persists or recurs, or if the victim says the
slightly forward, pinching the nostrils together.
nosebleed was a result of high blood pressure.
Q If the victim loses consciousness, place the
victim on his or her side to allow blood to drain from the nose. Summon EMS
personnel immediately.
Q
Figure 10-15
CHAPTER 10 FIRST AID
Eye Injuries
Care for open or closed wounds around the eyeball as you would for any soft tissue
injury. Never put direct pressure on the eyeball. For embedded objects in the eye:
Q
Q
Q
Q
Q
Summon EMS personnel.
Help the victim into a comfortable position.
Do not try to remove any object from the eye.
Bandage loosely and do not put pressure on the injured eyeball.
Stabilize the object as best as possible.
Figure 10-16
Depending on the size of the object, you may
be able to stabilize it by encircling the eye
with a gauze dressing or soft sterile cloth,
being careful not to apply any pressure to
the area. Position bulky dressings, such
as roller gauze, around the impaled object
and then cover it with a shield such as a
paper cup (Figure 10-16). The shield should
not touch the object. Bandage the shield
and dressing in place with a self-adhering
bandage and roller bandage covering the
patient’s injured eye, to keep the object
To care for an impaled object in the eye, stabilize the object with
stable and minimize movement.
For small foreign bodies in the eye, such as sand:
Q
Q
Q
a shield, such as a paper cup, and bandage the cup in place.
Tell the victim to blink several times to try to remove the object.
Gently flush the eye with water.
Seek medical attention if the object remains.
For chemicals in the eye, flush the eye continuously with water for 10 minutes or
until EMS personnel take over. Always flush away from the uninjured eye.
Injuries to the Mouth and Teeth
If a head, neck or spinal injury is not suspected:
Q
Q
Q
Q
Rinse out the victim’s mouth with cold tap water, if available.
Have the victim lean slightly forward or place
Figure 10-17
the victim on his or her side.
Try to prevent the victim from swallowing the
blood, which could cause nausea or vomiting.
Apply a dressing.
c For injuries inside the cheek, place folded
sterile dressings inside the mouth against
the wound.
c For injuries outside the cheek, apply
direct pressure using a sterile dressing
(Figure 10-17).
c For injuries to the tongue or lips, apply direct
Apply direct pressure using a sterile dressing to injuries
pressure using a sterile dressing. Apply cold
outside the cheek.
to reduce swelling and ease pain.
225
226
LIFEGUARDING MANUAL
Q
If a tooth is knocked out:
c Rinse out the victim’s mouth with cold tap water, if available.
c Have the victim bite down on a rolled sterile dressing in the space left by the
tooth (or teeth).
c Save any displaced teeth.
O
Carefully pick up the tooth by the crown (white part), not the root.
O
Rinse off the root of the tooth in water if it is dirty. Do not scrub it or
remove any attached tissue fragments.
O
Place the tooth in milk. If milk is not available, place the tooth in clean
water and keep the tooth with the victim.
c Advise the victim to get to a dentist with the tooth as soon as possible.
Scalp Injuries
Scalp injuries often bleed heavily. Putting pressure on the area around the wound
can control the bleeding.
Q
Figure 10-18
Q
Q
Control bleeding from a scalp injury by applying pressure
around the wound. Avoid direct pressure.
Apply gentle pressure at first because there
may be a skull fracture (Figure 10-18). If you
feel a depression, spongy areas or bone
fragments, do not put direct pressure on
the wound.
Summon EMS personnel if you cannot
determine the seriousness of the scalp injury.
For an open wound with no sign of a fracture,
control the bleeding with several dressings
secured with a bandage.
If you suspect a head, neck or spinal injury,
minimize movement of the head, neck and spine.
See Chapter 11, Caring for Head, Neck and
Spinal Injuries, on how to care for a head, neck or
spinal injury.
Embedded Objects
An object that remains in an open wound is called an embedded object. Take the
following steps to care for an embedded object:
Figure 10-19
Q
Q
Q
Summon EMS personnel.
Place several dressings around the object to
keep it from moving. Avoid placing pressure on
or moving the object.
Bandage the dressings in place around the
object (Figure 10-19). Do not remove the object.
Injuries to the Abdomen
Place several dressing around an embedded objective to keep it
from moving. Bandage the dressings in place around the object.
Be aware that wounds through the abdomen can
cause internal organs to push outside of the body.
To care for an abdominal injury:
Q
Summon EMS personnel.
CHAPTER 10 FIRST AID
Q
Q
Q
Carefully remove clothing from around the wound.
If organs are protruding:
c Do not attempt to put them back into the abdomen.
c Cover the organs with a moist, sterile dressing and cover the dressing with
plastic wrap.
c Place a folded towel or cloth over the dressing to keep the organs warm.
Care for shock.
Animal and Human Bites
An animal or human bite may be serious because of the nature of the wound and
risk of infection. A person who is bitten by an animal should be removed from the
situation if possible, but only without endangering yourself or others. Do not try to
restrain or capture the animal. Tetanus and rabies immunizations may be necessary,
so it is vital to report bites from any wild or unknown domestic animal to the local
health department or other agency according to local protocols. For animal or
human bites:
Q
Q
Q
Summon EMS personnel if the wound bleeds severely or if the animal is
suspected to have rabies.
For severe bleeding, control the bleeding first. Do not clean the wound; it will be
properly cleaned at the hospital.
If the bleeding is minor, wash the wound with large amounts of clean water. Saline
may be used, if available. Control the bleeding and cover with a sterile bandage.
Severed Body Parts
Caring for a victim with a severed body part can be disturbing. Remain calm and
take the following steps:
Q
Q
Q
Q
Q
Q
Summon EMS personnel.
Control the bleeding, and wrap and bandage
the wound to prevent infection.
Wrap the severed body part(s) in sterile gauze
(or clean material) (Figure 10-20).
Place the severed body part(s) in a plastic
bag and seal the bag. Put the plastic bag in
a container of an ice and water slurry (not on
ice alone).
Care for shock.
Be sure that the body part is taken to the
hospital with the victim immediately.
Figure 10-20
Wrap a severed body part in sterile gauze, put in a plastic
bag and put the bag on ice.
Burns
Burns are a special kind of soft tissue injury. Like other types of soft tissue injury,
burns can damage the top layer of skin or the skin and the layers of fat, muscle
and bone beneath. There are four sources of burns: heat, radiation, chemicals
and electricity.
Burns are classified by their depth. The deeper the burn, the more severe. Burns
can be superficial (first degree), partial thickness (second degree) or full thickness
227
228
LIFEGUARDING MANUAL
(third degree) (Figure 10-21, A–C). The severity of
the burn depends on the temperature or strength
of the heat or other source, length of exposure
to the burn source, location of the burn, area and
size of the burn and the victim’s age and general
medical condition.
Figure 10-21, A
Certain burns can lead to shock and need
immediate medical attention. These include burns:
Q
Q
Q
Figure 10-21, B
Q
Q
Q
That cause a victim to have difficulty breathing.
That cover more than one body part or a large
body surface area.
To the head, neck, hands, feet or genitals.
To the airway (burns to the mouth and nose
may be a signal of this).
To a child or an elderly person (other than very
minor burns).
From chemicals, explosions or electricity.
Caring for Burns
To care for burns, follow the general procedures
for a land emergency. If the scene is safe, check
the victim for life-threatening conditions. Summon
EMS personnel if the condition is life threatening.
The following general guidelines apply for all types
of burns:
Figure 10-21, C
Q
Q
Q
Q
Q
The three classifications of burns are: (A) superficial (first
degree), (B) partial thickness (second degree) and (C) full
thickness (third degree)
Stop the burning by removing the victim from
the source of the burn.
Cool the burned area with large amounts of
cold tap water at least until pain is relieved.
Cover the burned area loosely with a
sterile dressing.
Take steps to minimize shock, such as by keeping
the victim from getting chilled or overheated.
Comfort and reassure the victim.
Table 10-1 outlines specific considerations and
care steps for the different sources of burns.
BITES AND STINGS
Spider Bites and Scorpion Stings
Only two spiders in the United States are poisonous: the black widow and the
brown recluse. A bite from one of these spiders can cause serious illness or fatality.
Some scorpion stings also can be fatal. When patrons are bitten by spiders at
aquatic facilities, it is usually when they are reaching or rummaging in dark places,
such as lockers or storage areas. They are typically bitten on their hands or arms.
CHAPTER 10 FIRST AID
Table 10-1: Care Steps Based on Source of Burn
Electrical
Chemical
Q
Summon EMS personnel.
Q
Summon EMS personnel.
Q
Check the scene for
safety and check for lifethreatening injuries. If a
power line is down, wait
for the fire department
or the power company
to disconnect the
power source.
Q
Q
Cool the burn with cold tap
water until pain is relieved.
Brush off dry chemicals
with a gloved hand, being
careful not to get the
chemical on yourself or
to brush it into the victim’s
eyes. Flush the affected
area continuously with
large amounts of
cool water.
Q
Keep flushing the area for
at least 20 minutes or until
EMS personnel arrive.
Q
If a chemical gets into an
eye, flush the eye with
cool, clean running water
until EMS personnel arrive.
Always flush the affected
eye from the nose outward
and downward to prevent
washing the chemical into
the other eye.
Q
If possible, have the victim
remove contaminated
clothes to prevent further
contamination while
continuing to flush the area.
Q
Cover the burn with a dry,
sterile dressing.
Q
Be aware that
electrocutions can cause
cardiac and breathing
emergencies. Be prepared
to perform CPR or
defibrillation. Take steps to
minimize shock.
Radiation (Sun)
Q
Cool the burned area and
protect the area from further
damage by keeping it out of
the sun.
If someone has been bitten by a black widow or brown recluse spider or stung by
a scorpion:
Q
Q
Q
Q
Q
Q
Q
Q
Summon EMS personnel.
Wash the wound thoroughly.
Bandage the wound. Apply a topical antibiotic ointment to the bite to prevent
infection if the person has no known allergies or sensitivities to the medication.
Apply a cold pack to the site to reduce swelling and pain.
If it is available and local protocols allow, give the victim antivenin—a medication
that blocks the effects of the black widow spider’s poisonous venom.
Care for life-threatening conditions.
Monitor the victim’s condition and watch for changes in LOC.
Keep the victim comfortable.
229
230
LIFEGUARDING MANUAL
Snakebites
Snakebites kill few people in the United States. Whereas 7000 to 8000 venomous
snakebites are reported each year in the United States, fewer than five victims die
from the snakebite.
To provide care for a bite from a venomous snake:
Summon EMS personnel.
Q Keep the injured area still and lower than the heart. The victim should walk only
if absolutely necessary.
Q Wash the wound.
Q Apply an elastic roller bandage. Use a narrow bandage to wrap a hand or wrist, a
medium-width bandage to wrap an arm or ankle and a wide bandage to wrap a leg.
c Check for feeling, warmth and color of the limb beyond where the bandage
will be placed, and note changes in skin color and temperature.
c Place the end of the bandage against the skin and use overlapping turns
(Figure 10-22).
c Gently stretch the bandage while wrapping.
The wrap should cover a long body section,
Figure 10-22
such as an arm or a calf, beginning at the
point farthest from the heart. For a joint like a
knee or ankle, use figure-eight turns to support
the joint.
c Always check the area above and below the
injury site for warmth and color, especially
fingers and toes, after applying an elastic
roller bandage. By checking before and after
bandaging, you will be able to determine if
any tingling or numbness is a result of the
bandaging or of the injury itself.
c
Check the snugness of the bandage—a finger
Apply an elastic roller bandage using overlapping turns to
slow the spread of venom.
should easily, but not loosely, pass under the
bandage.
Q
For any snakebite do not apply ice, cut the wound, apply suction or apply a tourniquet.
Insect Stings
Insect stings can be painful. They also can be fatal for people who have severe
allergic reactions. Allergic reactions can result in a breathing emergency. If someone
is having a breathing emergency, summon EMS personnel.
To care for an insect sting:
Q
Q
Q
Examine the sting site to see if the stinger is in the skin (if there is one). Remove
the stinger if it is still present. Scrape it away with the edge of a plastic card,
such as a credit card.
Wash the wound with soap and water, cover the site with a dressing and keep
the wound clean.
Apply a cold pack to the site to reduce pain and swelling.
CHAPTER 10 FIRST AID
Q
Q
Q
Watch the victim for signals of an allergic reaction—shortness of breath; swelling
of the face, neck or tongue; rash or hives; or a tight feeling in the chest and throat.
Care for life-threatening conditions.
Monitor the victim’s condition, look for changes in LOC and keep the
victim comfortable.
Marine Life
The stings of some forms of marine life not only are painful, but they can make the
victim feel sick, and in some parts of the world, can be fatal (Figure 10-23, A–D).
The side effects of a sting from an aquatic creature can include allergic reactions
that can cause breathing and heart problems, as well as paralysis and death.
If the sting occurs in water, the victim should be moved to dry land as soon as
possible. Emergency care is necessary if the victim has been stung by a lethal
jellyfish, does not know what caused the sting, has a history of allergic reactions
to stings from aquatic life, has been stung on the face or neck, or starts to have
difficulty breathing.
Basic care steps for jellyfish stings are to remove the victim from the water,
prevent further injection of poisonous material by deactivating or removing
nematocysts (stingers) and control pain.
Figure 10-23, A
Figure 10-23, B
Figure 10-23, C
Figure 10-23, D
(A) Stingray, iStockphoto.com/Dia Karanouh; (B) Bluebottle jellyfish/Portuguese man-of-war, iStockphoto/Mark Kostich; (C) Sea
anemone, iStockphoto/Omers; (D) Jellyfish, Shutterstock/Johan1900
231
232
LIFEGUARDING MANUAL
There are some differences in specific care based on the region and the species
of jellyfish. The supervisor of the aquatic facility should inform you of the types of
jellyfish in the region, specific treatment recommendations and photographs of the
jellyfish to aid in identification.
To deactivate the stingers/tentacles for most types of jellyfish in most waters in
the United States, flush the injured part in vinegar as soon as possible for at least
30 seconds to offset the toxin. A baking soda slurry also may be used if vinegar
is not available. For “bluebottle” jellyfish, also known as Portuguese man-of-war,
which are found in tropical waters, flush with ocean water instead of vinegar.
Vinegar triggers further injection of poisonous material. Do not rub the wound or
apply fresh water, ammonia or rubbing alcohol, because these substances may
increase pain.
Carefully remove any stingers/tentacles with gloved hands or a towel. When
stingers are removed or deactivated, use hot-water immersion (as hot as can be
tolerated) for at least 20 minutes or until pain is relieved. If hot water is not available,
dry hot packs or, as a second choice, dry cold packs also may be helpful in
decreasing pain. Do not apply a pressure immobilization bandage.
POISONING
A poison is any substance that can cause injury, illness or death when introduced
into the body. Poisons can be in the form of solids, liquids, sprays or fumes (gases
and vapors). If a person is showing signals of poisoning, call the Poison Control
Center at 1-800-222-1222. If the person is unconscious or experiences a change in
LOC, or if another life-threatening condition is present, summon EMS personnel.
In an aquatic facility, the Material Safety Data Sheet (MSDS) is required on site for
every product/chemical in use. In the case of a known poisoning by a product or
chemical, the MSDS should accompany the victim to the doctor or hospital.
Ingested Poison
Ingested poisons are poisons that are swallowed and include the following:
Q
Q
Q
Q
Certain foods, such as specific types of mushrooms and shellfish
Drugs, such as excessive amounts of alcohol
Medications, such as too much aspirin
Household items, such as cleaning products, pesticides and certain
household plants
A person who has ingested poison generally looks ill and displays symptoms
common to other sudden illnesses. If you have even a slight suspicion that a person
has been poisoned, call the Poison Control Center.
Inhaled Poison
Poisoning by inhalation occurs when a person breathes in poisonous gases or
fumes. Poisonous fumes can come from a variety of sources. They may or may not
have an odor. Common inhaled poisons include:
Q
Carbon monoxide, which can come from car exhaust, fires or charcoal grills.
CHAPTER 10 FIRST AID
Q
Q
Chlorine gas, which is highly toxic. You will need special training to recognize
and treat this type of poisoning.
Fire extinguisher gases.
If someone has inhaled poisonous fumes:
Q
Q
Q
Q
Q
Q
Size-up the scene to be sure that it is safe to help the victim.
Summon EMS personnel.
Move the victim to fresh air.
Care for life-threatening conditions.
Monitor the victim’s condition and watch for changes in the LOC.
If conscious, keep the victim comfortable.
Absorbed Poison
An absorbed poison enters through the skin or mucous membranes in the eyes,
nose and mouth. Absorbed poisons come from plants, as well as from chemicals
and medications. Poison ivy, poison oak and poison sumac are the most common
poisonous plants in the United States. Some people are allergic to these poisons and
have life-threatening reactions after contact, whereas others may not even get a rash.
If someone has been exposed to a poisonous substance, remove exposed clothing
and jewelry and immediately rinse the exposed area thoroughly with water for 20
minutes, using a shower or garden hose if possible. If a rash or wet blisters develop,
advise the victim to see his or her health care provider. If the condition spreads to
large areas of the body or face, have the victim seek medical attention.
HEAT-RELATED ILLNESSES AND
COLD-RELATED EMERGENCIES
Exposure to extreme heat or cold can make a person ill. A person can develop a
heat-related illness or a cold-related emergency even when temperatures are not
extreme. Factors that may contribute to these emergencies include environmental
conditions, such as wind speed, humidity level and general working or living
conditions, as well as the victim’s personal physical attributes, such as age and
state of health and recent physical exertion.
Once the signs and symptoms of a cold-related emergency or heat-related illness
appear, the victim’s condition can quickly get worse and lead to death.
Heat-Related Illnesses
Heat-related illnesses are progressive conditions caused by overexposure to heat.
If recognized in the early stages, heat-related emergencies usually can be reversed.
If not recognized early, they may progress to heat stroke, a life-threatening condition.
There are three types of heat-related illnesses:
Q
Q
Heat cramps are painful muscle spasms that usually occur in the legs and
abdomen. Heat cramps are the least severe of the heat-related illnesses.
Heat exhaustion is an early indicator that the body’s cooling system is becoming
overwhelmed. Signs and symptoms of heat exhaustion include cool, moist,
233
234
LIFEGUARDING MANUAL
pale, ashen or flushed skin; headache, nausea and dizziness; weakness and
exhaustion; and heavy sweating.
Q
Heat stroke occurs when the body’s systems are overwhelmed by heat and stop
functioning. Heat stroke is a life-threatening condition. Signs and symptoms of
heat stroke include red, hot, dry skin; changes in LOC; and vomiting.
Caring for Heat-Related Illnesses
Take the following steps to care for someone suffering from a heat-related illness:
Q
Move the victim to a cool place.
Q
Loosen tight clothing and remove perspiration-soaked clothing.
Q
Cool the victim by spraying with cool water or applying cool, wet towels to
the skin.
Q
Fan the victim.
Q
Encourage the victim to drink small amounts of a commercial sports drink, milk
or water if the victim is conscious and able to swallow.
If the victim refuses water, vomits or starts to lose consciousness:
Q
Send someone to summon EMS personnel.
Q
Place the victim on his or her side.
Q
Continue to cool the victim by using ice or cold packs on his or her wrists,
ankles, groin and neck, and in the armpits. If possible, wrap the victim’s entire
body in ice-water-soaked towels.
Q
Continue to check for breathing and a pulse.
Cold-Related Emergencies
Temperatures do not have to be extremely cold for someone to suffer a cold-related
emergency, especially if the victim is wet or if it is windy.
Hypothermia
Hypothermia occurs when a victim’s entire body cools because its ability to keep
warm fails. A victim with hypothermia will die if care is not provided. The signs
and symptoms of hypothermia include shivering; numbness; glassy stare; apathy,
weakness or impaired judgment; and loss of consciousness.
To care for hypothermia:
Q
Perform a primary assessment, including a pulse check for up to 30 to 45 seconds.
Q
Summon EMS personnel.
Q
Gently move the victim to a warm place. Sudden movements may cause a heart
arrhythmia and possibly cardiac arrest.
Q
Remove any wet clothing.
Q
Warm the victim by wrapping all exposed body surfaces in blankets or by putting
dry clothing on the victim. Be sure to cover the head since a significant amount
of body heat is lost through the head.
c
Do not warm the victim too quickly, such as by immersing him or her in
warm water.
CHAPTER 10 FIRST AID
Q
Q
Q
If the victim is alert, have him or her drink liquids that are warm, but not hot,
and do not contain alcohol or caffeine.
If you are using hot water bottles or chemical hot packs, first wrap them in a
towel or blanket before applying.
Monitor the victim’s condition and watch for changes in LOC.
Frostbite
Frostbite occurs when body parts freeze from having been exposed to the cold. Severity
depends on the air temperature, length of exposure and the wind speed. Frostbite can
cause the loss of the nose, fingers, hands, arms, toes, feet and legs. The signs and
symptoms of frostbite include a lack of feeling in an affected area, swelling and skin that
appears waxy, is cold to the touch or discolored (flushed, white, yellow or blue).
To care for frostbite:
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Get the victim out of the cold.
Do not attempt to warm the frostbitten area if there is a chance that it might
refreeze or if you are close to a medical facility.
Handle the area gently; never rub the affected area.
Warm the affected area by soaking it in water not warmer than about 105° F until
normal color returns and the area feels warm (for 20 to 30 minutes). If you do
not have a thermometer, test the water temperature yourself. If the temperature is
uncomfortable to your touch, it is too warm.
Loosely bandage the area with dry, sterile dressings.
If the victim’s fingers or toes are frostbitten, separate them with dry, sterile gauze.
Avoid breaking any blisters.
Take precautions to prevent hypothermia.
Monitor the person and care for shock.
Summon EMS personnel to seek emergency medical care as soon as possible.
INJURIES TO MUSCLES, BONES AND JOINTS
Accidents, such as falls, are a common cause of injuries to muscles, bones and
joints. There are four types of muscle, bone and joint injuries:
Q
Q
Q
Q
Fracture—A complete break, a chip or a crack in a bone. Factures can be open
or closed.
c Closed fractures: The skin over the broken bone is intact.
c Open fractures: There is an open wound in the skin over the fracture.
Dislocation—Displacement of a bone away from its normal position at a joint.
These usually are more obvious than fractures.
Sprain—Tearing ligaments at a joint.
Strain—Stretching and tearing muscles or tendons.
It is difficult to know whether a muscle, bone or joint injury is a closed fracture,
dislocation, sprain or strain. However, you do not need to be able to identify the type
of injury because the type of care provided is universal. The objective is to keep the
injured area stable in the position found until EMS personnel take over.
235
236
LIFEGUARDING MANUAL
Caring for Muscle, Bone and Joint Injuries
When caring for muscle, bone and joint injuries, except for an open fracture, use the
general procedures for a land emergency and:
Q
Summon EMS personnel if the victim cannot move or use the injured area.
Q
Support the injured area above and below the site of the injury.
Q
Check for circulation and sensation below the injured area.
Q
Immobilize and secure the injured area only if the victim must be moved and
it does not cause further pain or injury. In many cases, it may be best to allow
EMS personnel to immobilize the injury prior to transport.
RICE
The general care for all musculoskeletal
injuries is similar: rest, immobilize, cold and
elevate or “RICE.”
Rest
Avoid any movements or activities that
cause pain. Help the victim to find the most
comfortable position. If you suspect head, neck
or spinal injuries, leave the victim lying flat.
Immobilize
Stabilize the injured area in the position in
which it was found. In most cases, applying
a splint will not be necessary. For example,
the ground can provide support to an injured
leg, ankle or foot, or the victim may cradle an
injured elbow or arm in a position of comfort.
Cold
Apply ice or a cold pack for periods of 20
minutes. If 20 minutes cannot be tolerated,
apply ice for periods of 10 minutes. If
continued icing is needed, remove the pack for
20 minutes, refreeze and then replace it.
Cold helps to reduce swelling, and eases pain
and discomfort. Commercial cold packs can
be stored in a kit until ready to use, or you can
make an ice pack by placing ice (crushed or
cubed) with water in a plastic bag and wrapping
it with a towel or cloth. Place a thin layer of
gauze or cloth between the source of cold and
the skin to prevent injury to the skin. Do not
apply an ice or cold pack directly over an open
fracture because doing so would require you to
put pressure on the open fracture site and could
cause discomfort to the victim. Instead, place
cold packs around the site. Do not apply heat
as there is no evidence that applying heat helps.
Elevate
Elevating the injured area above the level of
the heart helps slow the flow of blood, helping
to reduce swelling. Elevation is particularly
effective in controlling swelling in extremity
injuries. However, never attempt to elevate a
seriously injured area of a limb unless it has
been adequately immobilized.
CHAPTER 10 FIRST AID
Q
Recheck for circulation and sensation below the injured area.
Caring for an open fracture is described in a later section.
Immobilizing Muscle, Bone and Joint Injuries
Immobilizing a muscle, bone or joint injury helps keep the injured body part from
moving. This also may help to reduce any pain. Splinting is a method of immobilizing
an injured extremity and should be used only if moving or transporting a person to
seek medical attention and if splinting does not cause more pain.
If splinting is necessary, splint the injury in the position in which the injured area was
found. Splint the injured area and the joints or bones above and below the injury
site. Check for circulation and sensation before and after splinting.
A tool or device used to immobilize an injury is called a splint. Commercially
manufactured splints are widely available, but if necessary you can improvise one
from items available at the scene. The following can be used to immobilize common
muscle, bone and joint injuries:
Q
Anatomic splints. The person’s body is the splint. For example, an arm can be
splinted to the chest, or an injured leg to the uninjured leg.
Q
Soft splints. Soft materials, such as a folded blanket, towel, pillow or folded
triangular bandage, can be used to form a splint. A sling is a specific kind of soft
splint that uses a triangular bandage tied to support an injured arm, wrist or hand.
Q
Rigid splints. Boards, folded magazines or newspapers, or metal strips that do
not have sharp edges can serve as splints.
See the splinting skill sheets at the end of this chapter for specific steps to follow
when caring for arm, leg and foot injuries.
Caring for Open Fractures
An open fracture occurs when a broken bone tears through the skin and
surrounding soft tissue. To care for a victim with an open fracture, summon EMS
personnel, place sterile dressings around the open fracture, bandage the dressings
in place around the fracture, and do not move the exposed bone and limb. This may
cause further harm and great pain.
EMERGENCY CHILDBIRTH
If a pregnant woman is about to give birth, summon EMS personnel. Important
information to give to the dispatcher includes the pregnant woman’s name, age and
expected due date; the length of time that she has been having labor pains; and
whether this is her first child.
You should also speak with the woman to help her remain calm; place layers of
clean sheets, towels or blankets under the woman and over her abdomen; control
the scene so that the woman will have privacy; and position the woman on her back
with her knees bent, feet flat and legs spread apart.
237
238
LIFEGUARDING MANUAL
Remember, the woman delivers the baby, so be patient and let it happen naturally.
The baby will be slippery, so take care to avoid dropping the newborn. After delivery,
ensure that you clear the newborn’s nasal passages and mouth thoroughly, wrap the
newborn in a clean, warm blanket or towel and place him or her next to the mother.
Notes:
Q
Q
Q
Q
Do not let the woman get up or leave to find a restroom (most women at this
moment feel a desire to use the restroom).
Be sure to allow the woman’s knees to be spread apart to avoid causing
complications or harm to the baby.
Do not place your fingers in the woman’s vagina for any reason.
Do not pull on the baby.
Continue to meet the needs of the newborn while caring for the mother. Help the
mother to begin nursing the newborn, if possible. This will stimulate the uterus
to contract and help to slow the bleeding. The placenta still will be in the uterus,
attached to the newborn by the umbilical cord. Contractions of the uterus usually
will expel the placenta within 30 minutes. Do not pull on the umbilical cord.
Catch the placenta in a clean towel or container. It is not necessary to separate
the placenta from the newborn. Follow local protocols and medical direction for
guidance on cutting the cord.
WRAP-UP
As a professional lifeguard, you may need to care for patrons with a variety of
injuries and illnesses. An important part of your job is to provide these victims with
effective care. Remember to follow the general procedures for injury or sudden
illness on land until EMS personnel arrive and take over. This includes performing a
primary assessment and, if you do not find a life-threatening emergency, performing
a secondary assessment. You must know how to check a conscious person from
head to toe, take a brief SAMPLE history and provide the victim with whatever first
aid is needed.
SKILL SHEET
SECONDARY ASSESSMENT—USING SAMPLE
TO TAKE A BRIEF HISTORY
Notes:
Q
Q
When talking to children, get to eye level with the child, talk slowly and in a friendly manner,
use simple words and ask questions a child can easily answer.
If the child’s parents are nearby, ask for consent. If a parent or guardian is not available,
consent is implied.
Take a brief history using SAMPLE:
1
Signs and symptoms:
Q
Q
Q
2
Allergies:
Q
3
Q
Q
Q
Q
Have you recently been ill?
Do you have any medical conditions?
Have you experienced any recent falls, accidents or blows to the head?
Have you had surgery, been in a traumatic accident or had a medical emergency?
Last oral intake:
Q
Q
6
Do you have any medical conditions or are you taking any medications? If so, what
conditions do you have or what medications are you taking?
Have you taken any medications in the past 12 hours?
Pertinent past medical history:
Q
5
Do you have any allergies to medications or food? If so, what type of reactions have you
experienced when you were exposed?
Medications:
Q
4
What happened?
Where do you feel any pain or discomfort?
Do you have any numbness or loss of sensation? If so, where?
When did you last eat or drink?
What did you last eat or drink?
Events leading up to the incident:
Q
Q
What were you doing before the incident occurred?
What were you doing when the incident occurred?
239
240
LIFEGUARDING MANUAL
CHECKING A CONSCIOUS PERSON
Notes:
Q
Q
Q
Q
1
When checking an adult or child, explain what you are about to do.
If a child or an infant becomes extremely upset, conduct the check from toe to head.
Look for a medical ID tag, necklace or bracelet on the victim’s wrist, neck or ankle.
Do not ask the victim to move any area of the body that causes discomfort or pain, or if you
suspect a head, neck or spinal injury.
Check the head.
Q
Q
2
Check skin appearance and temperature.
Q
Q
Q
3
Q
Ask the victim to move his or her
head from side to side if there is no
discomfort and if an injury to the neck is
not suspected.
Note pain, discomfort or inability
to move.
Check the shoulders.
Q
5
Feel the victim’s forehead with the back
of your hand and note if the skin is cold
or hot.
Look at the color of the victim’s face
and lips.
Look at the victim’s skin and note if it is
moist or dry; or if it is red, pale, flushed
or ashen.
Check the neck.
Q
4
Look at the scalp, face, ears, eyes, nose and mouth for cuts, bumps, bruises
and depressions.
Note if the victim has any changes in LOC, such as dizziness, or feels light-headed.
Ask the victim to shrug his or her shoulders.
Check the chest and abdomen.
Q
Q
Q
Ask the victim to take a deep breath and blow air out.
Listen for difficulty or changes in breathing.
Ask the victim if he or she is experiencing pain during breathing.
SKILL SHEET
6
Check the arms.
Q
Q
7
Check one arm at a time.
Ask the victim to move his or her hand
and fingers and to bend the arm.
Check the legs.
Q
Q
Check one leg at a time.
Ask the victim to move his or her foot
and toes and to bend the leg.
8
Provide care for any conditions found.
9
Have the victim rest in a comfortable position if he or she can move all body parts without pain
or discomfort and has no other apparent signs or symptoms of injury or illness. Continue to
watch for changes in consciousness and breathing.
241
242
LIFEGUARDING MANUAL
CONTROLLING EXTERNAL BLEEDING
Note: Always follow standard precautions when providing care. Activate the EAP and summon
EMS personnel, if necessary. You can ask the victim to apply direct pressure with the dressing
while you put on your gloves, if necessary.
To control external bleeding:
1
Cover the wound with a dressing, such as a sterile gauze pad.
2
Apply direct pressure firmly against the
wound until bleeding stops.
3
Cover the dressing with a roller bandage
and secure it directly over the wound.
4
Check for circulation beyond the injury (check for pulse, skin temperature and feeling).
If the bleeding does not stop:
Q
Q
Q
Q
Apply additional dressings and bandages on top of the first ones and continue to apply
direct pressure.
Take steps to minimize shock.
Summon EMS personnel.
Follow local protocols when considering other methods of bleeding control, such as
applying a tourniquet.
SKILL SHEET
SPLINTING
Note: Splint only if necessary to move the victim before EMS personnel arrive.
Arm Injuries
1
Leave the arm in the position in which it was found or in the position in which the victim is
holding it.
2
Place a triangular bandage under the injured
arm and over the uninjured shoulder to form
a sling.
3
Tie the ends of the sling at the side of the
neck. Place gauze pads under the knots to
make it more comfortable for the victim.
4
Secure the arm to the chest with a folded
triangular bandage.
243
244
LIFEGUARDING MANUAL
SPLINTING
continued
Leg Injuries
1
Place several folded triangular bandages
above and below the injured body area.
2
Place the uninjured leg next to the injured leg.
3
Tie triangular bandages securely with knots.
Foot Injuries
Note: Do not remove the victim’s shoes.
1
Place several folded triangular bandages
above and below the injured area.
2
Gently wrap a soft object (pillow or folded blanket) around the injured area.
SKILL SHEET
3
Tie bandages securely with knots.
Rib and Breastbone Injuries
1
Place a pillow or folded towel between the victim’s injured ribs and arm.
2
Bind the arm to the body to help support the injured area.
Hand and Finger Injuries
1
For a hand injury, place a bulky dressing in the palm of the victim’s hand and wrap with a
roller bandage.
2
For a possible fractured or dislocated finger,
tape the injured finger to the finger next to it.
245
Was this manual useful for you? yes no
Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Download PDF

advertising