first responder workbook instructor...

First Responder Workbook

Instructor Edition

Advanced First Aid Workbook

Instructor Edition

Copyright © 2020 The Canadian Red Cross Society

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior written permission from The Canadian Red Cross Society.

techniques described in this publication are designed for use in lifesaving situations. However, the CRCS cannot guarantee that the use of such techniques will prevent personal injury or loss of life.

This publication is available in English and French.

ISBN: 978-1-55104-848-2

20 21 22 23 24 / 5 4 3 2 1

All brand names are included as examples only. The Canadian Red Cross Society does not endorse or recommend

AcknowledgementsWe would like to recognize Graham Scott for his invaluable contributions to this revised workbook.

First Responder Workbook – Instructor Edition Copyright © 2020 The Canadian Red Cross Society

| 4

Table of ContentsThe Professional Responder ..................................................................................................................................................................................5

Responding to the Call ..............................................................................................................................................................................................8

Infection Prevention and Control ....................................................................................................................................................................... 10

Anatomy and Physiology ....................................................................................................................................................................................... 13

Assessment ................................................................................................................................................................................................................ 18

Airway Management and Respiratory Emergencies ................................................................................................................................. 23

Circulatory Emergencies ....................................................................................................................................................................................... 27

Shock ............................................................................................................................................................................................................................. 31

Hemorrhage and Soft Tissue Trauma ............................................................................................................................................................. 33

Musculoskeletal Injuries ....................................................................................................................................................................................... 37

Chest, Abdominal, and Pelvic Injuries ............................................................................................................................................................. 40

Head and Spinal Injuries ....................................................................................................................................................................................... 43

Acute and Chronic Illnesses ................................................................................................................................................................................ 45

Poisoning ..................................................................................................................................................................................................................... 48

Environmental Illnesses......................................................................................................................................................................................... 51

Pregnancy, Labour, and Delivery ....................................................................................................................................................................... 54

Special Populations ................................................................................................................................................................................................. 57

Crisis Intervention .................................................................................................................................................................................................... 61

Reaching, Lifting, and Extricating Patients .................................................................................................................................................... 63

Transportation ........................................................................................................................................................................................................... 66

Multiple-Casualty Incidents ................................................................................................................................................................................. 68

Pharmacology ........................................................................................................................................................................................................... 72


The Professional Responder | 5

The Professional Responder

For Your ReviewRead Chapter 1 of Emergency Care for Professional Responders, then complete the following activities.

Key TermsReferring to Emergency Care for Professional Responders

Abandonment: Ending care of a patient without that patient’s consent or without ensuring that someone with equal or greater training will continue that care.

Protecting a patient’s privacy by not revealing any personal information you learn about the patient except to law enforcement or more advanced medical care personnel.

Consent:

An adverse stress reaction to an emergency situation, with signs and symptoms appearing soon after the traumatic event.

A legal responsibility of some individuals to provide a reasonable standard of emergency care; may be required by case law, statute, or job description.

A responder who has successfully completed a recognized training program in the care and transportation of a patient.

A network of community resources and medical personnel that provides emergency care to people who are injured or suddenly ill.

A person trained in emergency care who may be called on to provide such care as a routine part

Laws that protect people who willingly give emergency care while acting in good faith, without negligence, with reasonable care and skill, and within the scope of their training.

The process of speaking and listening to other people at an emergency scene; can be verbal or nonverbal.

Universal technical language used by medical professionals.

The failure to provide care at the level for which you are trained, thereby causing injury or damage to another.

Standing orders or medical control protocols (MCPs) issued by a medical director that allow responders to provide certain types of care and treatment without consulting with the physician. Also called “indirect medical control”.

“direct medical control”.



An adverse stress reaction to an emergency situation, with signs and symptoms appearing after the traumatic event and persisting over time.

The declining of care by a person.

The minimal standard and quality of care expected of an emergency care provider.

What Would You Do?

While you are driving to work one morning, you see

No. You are not on duty when the incident occurs.

a. Bandage the woundsb. Determine whether there are any other

injuries you can’t see

d. Call work and tell them you will be late

Position your vehicle to protect the scene, ensure the scene is safe before approaching.

Test Your Knowledge

a. Primary Care Paramedic

c. Critical Care Paramedicd. Emergency Medical Responder

stress:

b. Identify yourself with your namec. Indicate what you think may be wrong and

what you plan to dod. State your level of training

Any of the following: • Confusion• Lowered attention span• Poor concentration• Denial• Guilt• Depression• Anger• Unusual behaviour

• Change in interactionswith others

• Increased ordecreased appetite

• Uncharacteristic,excessive humour orsilence

Any of the following: • Completeness and accuracy• Objectivity• Legibility• Timeliness• Absence of alterations

✔

✔

✔



Abandonment b. Refusal of carec. Transfer of functiond. Competence

i. The signs and symptoms of CIS usuallyappear soon after the event.

T or Fii. The signs and symptoms of CIS usually last

much longer than those of PTSD. T or F

iii. You should try to deal with stressfulsituations on your own before turning toprofessional mental health services. T or F

iv. Signs and symptoms of CIS can includeconfusion, anger, and increased ordecreased appetite.

T or Fv. CIS can be caused by any emergency

response, regardless of the circumstances. T or F

a. Write down everything the physician saysb. Repeat any orders back to the physicianc. Present all information rapidly

b. Beginning to speak at the same time youpush the “push to talk” button

c. Holding the radio right up to your mouthd. Relaying all information you have collected at

the scene up to that point

Any of the following:


• A base station• Mobile radios• Portable radios• Repeaters

• Mobile phones• Satellite phones

• Maintaining a healthy diet by eating sensibly andregularly.

• Getting adequate sleep.• Engaging in regular exercise.• Participating in activities outside of work (hobbies).• Paying attention to your stress level, and taking

precautions against exceeding your own limits.• Understanding how you react to stressful

situations and having a self-care plan outliningprotective systems that you can rely on when indistress.

✔

✔

✔

✔ ✔

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✔

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Responding to the Call | 8

Responding to the Call



Substances that are harmful or toxic to the body; can be liquids, solids, or gases.

What Would You Do?

1. As you approach the scene, you see a placard on

appropriate action to take?a. Opening the truck’s doors and investigating

what the substance is

c. Having bystanders gather buckets of water in

d. Checking to see if any houses nearby have achainsaw so you can cut down the tree

a. Climbing into the car to assess the peopleinside

b. Asking the people in the car to climb out

d. Gathering people to help you roll the carupright

Test Your Knowledge

a. Ensuring safety for yourself and anybystanders

b. Gaining access to the patient(s)

d. Determining any threats to the patient’s life

a. Twice the length of the span of the wireb. Half the distance between the two poles

from which the broken wire has been strung

d.

a. Chemical transport tanks and/or placardsb. Clouds of vapour or spilled solids or liquidsc. Unusual odours

i. They should be created as soon as you arriveat the scene of the emergency. T or F

ii. They require you to be aware of the speciallytrained personnel in your community andhow to contact them.

T or F

✔

✔

✔

✔

✔✔

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Responding to the Call | 9

iii.larger areas.

T or Fiv. Once established, they must be practiced

regularly. T or F

v.circulated outside of your agency. T or F

Drug Labs:

Do not enter the scene until trained personnel arrive.

Hostage Situations:

Crime Scenes:

a. When you must access a patient to performimmediate life-saving interventions

b. When there are no other responders on thescene

d.space has adequate ventilation systemsoperating



Any four of the following:

• Request law enforcement personnel,• Remain at a safe distance until you are

summoned by law enforcement personnel.• Try to get any information from bystanders that

may help law enforcement personnel.

• Retreat and wait until police arrive and indicate itis safe to enter the area

• Do not touch anything except what you must togive care.

• Use one path to enter and exit.• Once you enter a crime scene to give care, make

sure that police are aware of your presence andactions.

• Document anything that you interact with.

••• Composition/

Information ofingredients

• First aid measures•• Accidental release

measures• Handling and storage• Exposure controls/

Personal protection

• Physical and chemicalproperties

• Stability and reactivity• Toxicological

information• Ecological information• Disposal

considerations• Transport information• Regulatory

information• Other information

✔

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Infection Prevention and Control | 10

Infection Prevention and Control



The transmission of a disease by inhaling infected airborne droplets when an infected person coughs or sneezes.

Single-celled micro-organisms that may cause infections.

humans.

Methicillin-resistant Staphylococcus aureus (MRSA) that occurs in groups of people who have not been recently hospitalized or have not had a medical procedure.

A viral infection of the liver.

A viral infection that causes eruptions of the skin and mucous membranes.

state is referred to as AIDS.

The transmission of a disease by touching a contaminated object.

A condition caused by disease-producing micro-organisms, also called pathogens or germs, in the body.

Disease capable of being transmitted from people, objects, animals, or insects.



laden droplets from coughing or sneezing.

A disease-causing agent; also called a micro-organism or germ.

A viral respiratory illness caused by the SARS-associated Coronavirus

A respiratory disease caused by a bacterium.

The transmission of a disease by an animal or insect bite through exposure to blood or

A disease-causing agent or pathogen that requires another organism to live and reproduce.

What Would You Do?

Disposable gloves, mask, protective eyewear

a. Meningitis

c. Kidney stonesd. Chickenpox/shingles

a. Direct contactb. Indirect contactc.

Test Your Knowledge

a.b. Hepatitis and chicken pox

d. Herpes and tetanus

i. A pathogen is present.

ii. There is enough of the pathogen to causedisease.

iii. A person is susceptible to the pathogen.

iv. There is a route of entry.

✔

✔

✔



i. Practise good personal hygiene.

ii. Wear personal protective equipment (PPE).

iii. Follow other occupational/workplaceprocedures.

iv. Clean and disinfect equipment.

i. It should identify the individual or individualswho will receive exposure control training,PPE, and vaccinations.

ii. It should contain a written record of tasksin which exposure to blood or other bodily

iii. It should also specify how a possibleexposure incident will be evaluated and describe the system whereby soiled

disposed of.

iv. It should specify the reporting procedures

a. Go to a hospital to be tested

c. Determine what type of disease it isd. Contact the Poison Control Centre

a.after a call

c. When caring for someone with signs of aninfectious respiratory illness

d. Both b and c

a. Tuberculosis and rubellab. Typhus and diphtheria

d.

Disease Vaccination

Meningitis Airborne, direct and indirect contact Yes

Hepatitis A Direct andindirect contact Yes

Hepatitis C Direct andindirect contact No

Tuberculosis Airborne No

Airborne Yes

Direct contact No

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Anatomy and Physiology



The natural, neutral position of the body.

The basic unit of all living tissue.

A group of organs and other structures that carry oxygen-rich blood and other nutrients throughout the body and remove waste.

A group of organs and other structures that digest food and eliminate waste.

A group of organs and other structures that regulate and coordinate the activities of other

A group of organs and other structures that eliminate waste and enable reproduction.

infection.

A group of tissues and other structures that supports the body, protects internal organs, allows movement, stores minerals, manufactures blood cells, and creates heat.

A group of organs and other structures that regulates all body functions.

A group of organs and other structures that bring air into the body and remove waste through a process called breathing or respiration.

Tendon:

Organs whose functions are essential to life, including the brain, heart, and lungs.


Anatomy and Physiology | 14

What Would You Do?

i. Elbow: Proximal

ii. Shoulder: Distal

Superior

a. Nervous and respiratoryb. Endocrine and nervous

d. Circulatory and digestive

Test Your Knowledge

Proximal

Distal

Right Left

Medial

Lateral

Diaphragm

Thoracic cavity

Spinal cavity

Cranial cavity

Abdominal cavity

Pelvic cavity

Bronchioles

BronchiLungs

Jaw

Tongue

Mouth

Nose

Nasopharynx

Pharynx

Oropharynx

Epiglottis

Larynx

Trachea

✔



, cranium, face, ribs, spinal column, coccyx, thorax, fibula.

Inferior vena cava

Arteries

Superior vena cava Aorta

Heart

Pulmonary arteries

Pulmonary veins

Patella

Tibia

FemurCoccyx

Ulna

Pelvis

Radius

Humerus

Sternum

Ribs

Scapula

Clavicle

SkullCranium

Face

Thorax

Spinal column

Fibula



Purpose

Supplies the body with oxygen through breathing.

Bones, muscles, joints, ligaments, tendons

Nervous

Breaks down food and eliminates waste

Integumentary

Heart, arteries, veins, capillaries, blood

i. Respiratory

ii. Circulatory

a. The stomach

c. The sinusesd. The intestines

a. From the heart to the body tissuesb. From the lungs to the heartc. From the heart to the lungs

b. Secrete hormonesc. Produce white blood cellsd. Transport nutrients to cells

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a. Medial, lateral

c. Proximal, distald. Anterior, posterior

b. Keep hormones distributed throughout thebody

c. Regenerate nervous tissue after injuryd.

Trachea

Fibula

Spinal cord

Aorta

Sacrum

Deltoid

Dermis

Lymphatic duct

Pancreas

Patella

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✔



Assessment



The force exerted by blood against the blood vessel walls as it travels throughout the body.

A large artery located in the upper arm.

Arteries located in the neck that supply blood to the head and neck.

A brief description, usually in the patient’s own words, of why EMS personnel were called to the scene.

A bluish colouration of the skin and mucous membranes due to the presence of deoxygenated blood in the vessels near the skin’s surface.

A standardized system used to determine a patient’s level of responsiveness; often performed on patients with suspected head injuries.

The process of measuring the level of glucose circulating in the blood.

A method of opening the airway when there is no suspected head and/or spinal injury.

A method of opening the airway when there is a suspected head and/or spinal injury.

A patient’s state of awareness, ranging from being fully alert to unresponsive.

The event or forces that caused a patient’s injury.

A check for conditions that are an immediate threat to a patient’s life.

A simple, rapid, safe, and non-invasive method used to measure the percentage of oxygen saturation in the blood.


Assessment | 19

A hands-on check that is completed quickly, unless intervention is required; used to look for life-threatening injuries and conditions.

The category that describes patients who require immediate transport to medical care; associated with load-and-go emergencies.

The number of times a patient breathes per minute.

A check for injuries or conditions that could become life threatening if not cared for.

The reduction or limitation of spinal movement.

The decision on whether a patient requires immediate transport.

Important information about the patient’s condition, obtained by checking level of responsiveness, breathing, pulse, skin characteristics, blood pressure, and pupils.

What Would You Do?

i. Pulse oximetry (SpO2)

ii. Rapid Body Survey

iii. Transport Decision

Vital Sign

Level of responsiveness: Unresponsive

Breathing: 10, shallow, and regular

Pulse: 100, strong, and regular

Vital Sign

Skin: Pale, cool, and clammy

Blood pressure: 120/60

Pupils: Equal, round, and reactive to light

a. The child’s sleeping patterns, eating times,and vaccination records

c. The child’s age, address, and schoold. The child’s normal vital signs (e.g. respiratory

rate, temperature) and typical behaviour

✔


Assessment | 20

Vital Sign

Level of responsiveness: Reactive to verbal stimuli

Breathing: 14, strong, and regular

Pulse: 100, strong, and regular

Skin: Warm and pink

Blood pressure: 110/60

Pupils: Equal, round, and reactive to light

Test Your Knowledge

Scene Assessment

Primary Assessment

Reassessment

Secondary Assessment

Treatment/Interventions

Documentation of Findings

Ongoing Assessment

ABC

Airway

Breathing

Circulation

igns and symptoms

Allergies

edications

Past/present medical history

Last oral intake

Events before the incident

AVPU

Alert

Verbal

Painful

Unresponsive

Neck (Carotid)

Arm (Brachial)Wrist (Radial)

Leg (Femoral)

Foot (Dorsalis pedis)

Foot (Posterior tibial)


Assessment | 21

Onset

Provocation

Quality

egion and radiation

everity

Time

Vital Sign

120/72 Blood pressure

Alert and oriented Responsiveness

Equal, round, and reactive to light

Pupils

14, regular, and deep Respiration

Pupils

76, regular, and strong Pulse

93, weak, and irregular Pulse

130/P Blood pressure

Pale, cool, and clammy Skin

GCS of 13 Responsiveness

Red, hot, and dry Skin

Unresponsive Responsiveness

b.c.

enoughd. The patient’s heart is not beating

a. A fracture of the elbowb. An impaled object in the right hand

d. None of these injuries should be treated untilafter the secondary assessment

a. Whether the patient is ill or injuredb. The patient’s sex and approximate age

d. The patient’s chief complaint or problem

a. A 30-year-old woman who has a bruise onher leg from a soccer ball

c. A 10-year-old girl who is crying because of abee sting

d.his back after swimming 30 lengths of thepool

a. Determine whether the patient is in shock;identify whether the patient is still in shock orif your treatment has helped

b. Identify any hazards that are a threat to thoseat the scene; determine what else might bewrong with the patient

c. Determine the initial vital signs to comparewith during later monitoring; identify anyallergies or medications the patient mighthave

i. Interview with Patient and Bystanders

ii.

iii. Head-to-Toe Physical Examination

✔

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Assessment | 22

Any three of the following:•• Glucometer• Pulse oximeter• Stethoscope• Flashlight• Thermometer


Assessment | 23

Airway Management and Respiratory Emergencies



A complete or total blockage of a patient’s airway.

A severe allergic reaction in which the air passages constrict and restrict the patient’s breathing.

Taking blood, vomit, saliva, or other foreign material into the lungs.

Breathing that is slower than usual.

A disease characterized by a loss of lung function.

A disease in which the alveoli lose their elasticity, become distended with trapped air, and stop working.

A technique used to remove foreign material from a patient’s airway.

Rapid breathing that upsets the body’s balance of oxygen and carbon dioxide.

A condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level.


Airway Management and Respiratory Emergencies | 24

A device prescribed to many people with asthma, containing a medication that

inadequate oxygen in the blood.

A condition in which breathing has stopped.

Rapid breathing.

What Would You Do?

a. Have the patient lie on the ground and beginchest compressions

b. Stand behind the patient and beginabdominal thrusts

c. Do nothing until the patient stops makingsounds

a. Attempt to give her a ventilationb. Check for bystanders who can answer

SAMPLE questions

d.

a. Do 30 chest compressions

c. Roll the patient into the recovery positiond. Recheck the patient’s ABCs

T or F

a. Nervous, endocrine, and genitourinaryb. Integumentary, endocrine, musculoskeletal,

and nervousc. Digestive, respiratory, and genitourinary

Nausea, vomiting.

✔

✔

✔

✔

✔



Test Your Knowledge

Condition Description

An obstruction in the airway

A narrowing of the air passages

A disease in which carbon dioxide/oxygen exchange is not

A swelling of the air passages due to a reaction to an allergen

A disease causing excessive mucous secretions and anti-

to the bronchi

Breathing faster than normal

a. A glucometer

c. A pulse oximeterd. A metered-dose inhaler

b. Performing CPRc. Having the patient lie down, keeping the

patient coold. Ensuring the area is well-ventilated,

performing abdominal thrusts

a. Check for signs of circulation, including apulse, for no more than 5 to 10 seconds

b. Check the patient’s level of responsivenessc. Continue providing assisted ventilation

a. The smell of the mask is bothering thepatient

c. The patient had been poisoned and theventilations caused the stomach to expel thepoison

d. The lungs are reacting to the positivepressure of the ventilations

a. Remove them immediately to prevent themfrom obstructing the patient’s airway

b. Always keep them in; if you take them outthey will most likely get lost or broken

d. Check the patient’s wallet for a card thatexpresses what they want a rescuer to dowith the dentures in case of an emergency

i. The tip of a suction device is referred to as acatheter. T or F

ii. It is good practice to have a suctioning uniton standby whenever you are providingassisted ventilations to an unresponsivepatient. T or F

iii.removing solids. T or F

iv. Suction devices are not suitable for use onresponsive patients. T or F

v. The distance of insertion for a suction deviceis the distance from the patient’s earlobe tothe corner of the mouth. T or F

✔

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✔

✔

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a. Do 30 chest compressionsb. Attempt another ventilation with slightly

more forcec.

a.b. On a soft surface such as a folded blanket

d.

a. 12.6 minutesb. 16 minutesc. 20.4 minutes

i. Dyspnea

ii. Abnormal breathing sounds

iii. Abnormal respiratory rate

iv. Abnormal skin characteristics

v.

vi.

vii. Patient position

i. Anatomical airway obstruction

ii. Foreign-body airway obstruction

• The patient begins to breathe.• The patient’s pulse is absent.• You transfer care to another person with the same

• You are too exhausted to continue.• The scene becomes unsafe.✔

✔

✔


Circulatory Emergencies | 27

Circulatory Emergencies



Commonly sold under the brand name Aspirin®, this medication thins the blood and reduces the formation of clots.

Chest pain or pressure resulting from the heart needing more oxygen-rich blood than it is getting; pain or pressure usually lasts less than 10 minutes; also called angina pectoris.

An electronic device that shocks a patient’s heart to stop certain arrhythmias.

A condition in which the heart has stopped functioning.

A technique that combines rescue breathing and chest compressions for a patient whose breathing and heart have stopped.

A disease of the heart and blood vessels; commonly known as heart disease.

A fatty substance made by the body and found in certain foods.

Sudden illnesses or injuries involving the heart or blood vessels.

results in heart failure.

Blood vessels that supply the heart muscle with oxygen-rich blood.

The death of cardiac muscle tissue due to a sudden deprivation of circulating blood; heart attack.

A medication often prescribed to people diagnosed with angina.

Rapid heart rate.

mini-stroke.



What Would You Do?

Whether he has recently taken erectile dysfunction medication for any reason.

b. Yes, if the pain is not relieved immediatelyc. Yes, if the pain gets any worsed. No: a patient should not take more than one

dose of nitroglycerin per day

i. Be calm and reassuring

ii. Have the patient chew 160 to 325 mg ofacetylsalicylic acid (ASA)

iii. Be prepared to perform CPR

It could quickly lead to cardiac arrest.

a. Nothing, as you should not use an AED on achild

b. Nothing, as you should not use an AEDon someone with a pre-determined heartproblem

d. Stop CPR

electrodes.

a. Use only one electrode padb. Move the lower electrode pad further toward

the abdomen to make space between thepads

c. Do not use the AED on the child

Resume CPR

✔

✔

✔



Test Your Knowledge

i. Onset: Did it start suddenly or develop overdays, hours, etc.?

ii. Provocation: What provokes the pain orcauses it to get worse?

iii. Quality: What does the pain feel like (sharp,dull, stabbing, moving, etc.)?

iv. Region and Radiation: Where exactly is thepain located? Does it radiate to other areas?

v. Severity: On a scale of 0 to 10, how bad is thepain?

vi. Time: When did the pain start?

i. FAST

ii. Cincinnati Pre-Hospital Stroke Scale (CPSS)

• You transfer care of the patient to someonewith equal or greater training

• You become too tired to continue• The patient's pulse returns (ROSC)• The scene becomes unsafe

Adult Child Neonate

Hand Positionsternum on sternum sternum (just below

nipple line)

Encircling method

Depth1/3 of the chest depth

One-Responder Cycle

3 compressions1 ventilation

Cycle30 compressions2 ventilations

100–120 per minute (30 compressions in 15–18 seconds)



a. Their hearts are not fully developed yetb. There are a large number of diseases that

c. Their brains are not yet fully programmed toregulate the heart’s electrical system

b. Have the compressor stop every minute toreassess the ABCs

c.d. All of the above

a. Reverse the damage the myocardium mayhave sustained while deprived of oxygenatedblood

c. Prevent clinical death from occurringd. None of the above

a. Unresponsiveness

c.d. Blueness around the lips

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✔ ✔


Shock | 31

Shock



Excessive sweating

The circulation of blood throughout the body.

A life-threatening condition that occurs when the circulatory system fails to provide adequate oxygen-rich blood to all parts of the body.

A position in which a patient is in a supine position with his or her feet elevated 20 to

What Would You Do?

b.her cardiovascular system

c. She is mad at the driver for hitting her, andher stress level is high

d. Nothing is wrong, as these vital signs arenormal for a someone of her age

a. Shake her to wake her upb.

d. Take note of her level of responsiveness andmove on to checking her pupils

a. Take her blood pressureb. Recheck her vital signsc. Suction her airway and then increase oxygen

Test Your Knowledge

a. Provide a sugary snack or drinkb. Give the patient plenty of waterc. Keep the patient as cool as possible

• Place the patient in the rapid transport category•• Help the patient rest comfortably• Help the patient maintain a normal body

temperature

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Shock | 32

G Neurogenic A

C Psychogenic B

D Septic C Factors such as emotional stress cause blood to pool in the body in areas away from the brain because of vessels dilating

E Anaphylactic D Poisoning caused by severe infections that cause blood vessels to dilate

A Cardiogenic E Life-threatening allergic reaction to a substance

B Hemorrhagic F

F Obstructive G Failure of the nervous system to control the size of blood vessels, causing them to dilate

a. The blood becomes poisonous

c. There is not enough blood in the circulatorysystem

d. Carbon dioxide is not being released fromthe tissues in large enough quantities

a. The heart beats faster; therefore, the body’sheat is used as energy

b. The heart slows down; therefore, less heat isproduced

d. The body cools itself to conserve energy

a. A teenager damages her spine in a divingincident

b. A worker loses his arm to a piece of farmingequipment

c.

a. Supine with the head elevated

c. Seated comfortably in a chaird. On a long backboard

a. Administering oxygenb. Maintaining normal body temperature

d. Providing rest and reassurance

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Hemorrhage and Soft Tissue Trauma | 33

Hemorrhage and Soft Tissue Trauma



Bandage: Material used to wrap or cover a part of the body; commonly used to hold a dressing or splint in place.

Burn: An injury to the skin or other body tissues caused by heat, chemicals, electricity, or radiation.

A wound in which soft tissue damage occurs beneath the skin but the skin is not broken.

emergency care.

The pressure applied to a wound to control bleeding.

Bleeding from an open wound in the skin.

A burn injury involving both layers of skin and underlying tissues; skin may be brown or charred, and underlying tissues may appear white.

A loss of a large amount of blood in a short time.

Bleeding that occurs inside the body.

A wound resulting in a break in the skin surface.

A burn injury involving both layers of skin; characterized by red, wet skin and blisters.

Pressure bandage: A bandage applied snugly to create pressure on a wound to aid in controlling bleeding.

Body structures that include the layers of skin, fat, and muscles.



A burn injury involving only the top layer of skin, characterized by red, dry skin.

A constricting band applied over an artery above the site of an open wound with severe bleeding; used

What Would You Do?

workers was trying to remove something jammed

did not get his hand out in time, and his hand has

a. Performing a secondary assessment andlooking for any other injuries

c. Taking a set of vital signsd. Retrieving the hand from the baler

b. Hemothoraxc. Anginad. Infection

a. 9%18%

c. 27%d. 36%

i. This is considered a critical burn. T or F

ii. This patient requires more advanced medicalcare. T or F

iii. You should not begin providing care forthis patient until you have completed a fullsecondary assessment. T or F

b. Sterile occlusive dressingsc. More cool clothsd. Nothing

Test Your Knowledge

i. Abrasions

ii. Lacerations

iii. Avulsions

iv. Punctures

• Discoloration of theskin (bruising) in theinjured area.

• Soft tissues that aretender, swollen, or

• Anxiety orrestlessness.

• Rapid breathing(tachypnea).

• Skin that feels cool ormoist or looks pale orbluish.

• Nausea and vomiting.• Excessive thirst.• Declining level of

responsiveness.• A rapid, weak pulse.• A drop in blood

pressure.

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a. Blood oozing from a woundb. Blood that fails to clot after you have tried to

control itc. Blood spurting from a wound

a. Obtaining more advanced medical careb. Administering supplemental oxygen

d. Treating the patient for shock

a. Arterial clamping

c. Elastic bandagingd. Hyperbaric recompression

a. Preventing air from reaching a woundb. Providing a sterile covering for a wound

d. Preventing germs from reaching a wound

a. Burnsb. Spinal injuriesc. Entry and exit wounds

a.b. Partial-thickness burn

d. None of the above

T or F

b. Cool the area with cool running waterc. Apply a cold compress to the aread. Cover the area with a non-stick sterile

dressing

a. A 35-year-old man with a full-thickness burnon his hand

b. A 7-year-old child with a sunburn on his backc. A 72-year-old woman with a blistered burn

on her leg

a. An underlying chronic illnessb. Severe internal bleeding

d.

4.5% 4.5%

4.5%4.5%

18%

1%

18%

9% 9%

9%

4.5%

9%

4.5%

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b. The epistaxis is the fourth nosebleed in aone-year period

c. The epistaxis is caused by low bloodpressure

d.patient has ever had

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Musculoskeletal Injuries | 37

Musculoskeletal Injuries



The displacement of a bone from its normal position at a joint.

The limbs of the body.

A break or disruption in bone tissue.

A device used to immobilize body parts.

The excessive stretching and tearing of ligaments and other soft tissue structures at a joint.

The excessive stretching and tearing of muscles and tendons at a location other than a joint.

What Would You Do?

a. A hip injuryb. A broken ankle

d. Shock

a. Applying a traction splintb. Securing the injured leg to the uninjured legc. Applying a rigid splint

i. Check the patient’s pulse

ii. Check the patient’s skin colour

iii. Check the patient’s temperature

iv.

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a.b. Radius and humerusc. Scapula and clavicle

b. Consist of a sling onlyc. Ensure the arm is straightd. Include traction

T or F

a. Treat the patient for shockb.

d. Put a mitten or glove on the hand

Test Your Knowledge

To ensure that the splint isn’t so tight that it

i. Pain

ii. Swelling

iii. Deformity

iv. Discoloration of the skin

v.

i. Rest

ii. Immobilize

iii. Cold

iv. Elevate

i. Soft

ii. Rigid

iii. Anatomical

iv. Traction

Rest, immobilize, cold, and elevate the injured area. Apply a rigid long splint on the lateral side from below the hip to below the foot. Place a shorter padded splint on the medial side from the groin to the foot.

a. It freezes the skin to numb the pain

c. It decreases the temperature of the area toan optimal healing temperature

d. It kills any pathogens that may causeinfection

•• A snapping or popping sound at the moment of

injury.• A mechanism of injury that suggests the trauma

may be severe.• Crepitus.• Moderate to severe swelling and/or discoloration.••• Loss of circulation or sensation in an extremity.

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b. To lessen painc. To prevent further damage or injuryd. To reduce the risk of serious bleeding

b. Return it to the normal anatomical positionand then immobilize it

c. Have the patient extend the leg and hold it inplace

d. Avoid immobilizing the injury

a. Return the limb to the normal anatomicalposition

c. Push any exposed bones back under the skind. Elevate the injury

a. Triangular patternb. Joint-hook patternc. Extremity-relief pattern

a. Ensure that it allows the patient’s arm tobend at the elbow

b. Ensure that it does not extend beyond thepatient’s wrist

c. Ensure that it applies direct pressure to theinjured area

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Chest, Abdominal, and Pelvic Injuries | 40

Chest, Abdominal, and Pelvic Injuries



A rupturing of the abdominal aorta.

A condition in which abdominal organs protrude through a major wound in the abdomen.

An injury involving fractured ribs that become completely separated from the rib cage and do not move with the rest of the chest during respiration.

The state of being blocked or sealed, not allowing air passage.

The movement of one part of the chest wall in the opposite direction from the rest of the chest wall.

A condition in which air enters the pleural space, usually as a result of a blunt or penetrating trauma.

A type of penetrating chest injury in which a sucking sound is heard with each breath a patient takes due to air freely passing in and out of the chest cavity.

the lung to collapse.



What Would You Do?

a. Fractured rib

c. Flail chestd. Kidney perforation

a. Sterile gauzeb. An adhesive bandage

d. A triangular bandage

a. Flail chestb. Hemothoraxc. Abdominal aortic aneurysm

1. Which of the following should you do?a. Cover the protruding organs with a moist

sterile dressingb. Cover the patient with a dry dressing or towel

to maintain warmthc. Remove clothing from around the wound

a. Sitting positionb. Recovery position

d. Prone position

T or F

Test Your Knowledge

Nausea and vomiting

Pale skin

Thirst

C Coughing up blood

C Obvious deformity

C

Protruding organs

Tenderness in the abdomen

C Pain at the injury site that increases with movement

C Flushed skin

C Bluish skin

Bruising

a. Pancreasb. Gallbladder

d. Liver

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b. Rupture of the spleenc. Fracture of the femurd. Heart attack

a. Digestive enzymesb. Blood

d. Tissue

a. Bent with knees pulled towards the chestb. Lower than the patient’s headc. Raised approximately 15 cm (6 in)

b. Tightly bind the patient’s arm to the chest toform an anatomical splint

c. Place the patient in the recovery positiond. Bind the entire chest, ensuring you do not

restrict the patient’s breathing

a. Infectionb. Gastroenteritis

d.

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Head and Spinal Injuries | 43

Head and Spinal Injuries



A rigid device positioned around the neck to limit movement of the head and neck.

A technique used to bring a patient’s head and neck into neutral alignment and minimize movement.

Any technique for limiting movement of the patient’s neck and/or spine.

What Would You Do?

a. Immobilize the nail in his eyeb. Do a head-tilt/chin-lift and check for normal

breathingc. Put him in the recovery position

Yes:

a. An epidural hematomab. A subdural hematomac. A C-spine Injury

Test Your Knowledge

Apply a cervical collar

Ensure the patient is in the correct position on the board

Immobilize the head to the board

Begin manual in-line stabilization

Secure the chest to the board

Secure the legs to the board

Log-roll the patient on his side

Log-roll the patient onto the board

Secure the pelvis to the board

i. A patient found unresponsive with anunknown cause.

ii. Any fall from a height greater thanapproximately 1 metre (3.3 feet).

• The patientexperienced trauma.

• The patient is alert.• The patient’s vital

signs are stable.

• The patient is 16years old or older.

• The patient has noacute paralysis

2

5

9

1

6

8

3

7

4

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Head and Spinal Injuries | 44

iii. Any motor vehicle collision.

iv. Any injury in which a patient’s helmet is badlydamaged or broken.

v. Any injury involving a severe blunt force tothe head or trunk.

vi. Any penetrating injury to the head, neck, ortrunk.

vii. Any head injury that occurs when a patient isdiving.

viii. Any incident involving electrocution(including lightning strikes).

a. The patient’s head is severely angulated toone side

b. You encounter resistance when attemptingto move the head

c. The patient complains of pain when youattempt to move the head

a. Applying direct pressure to the injured areawith your gloved hand

c. Bandaging the area securelyd. Placing the patient in the recovery position

i. SMR is generally indicated for any patientwho is not fully alert. T or F

ii. SMR is generally indicated for a patientwho was injured in a simple rear-end motorvehicle collision. T or F

iii. SMR is generally indicated for any patientwith deferred onset of neck pain after aninjury. T or F

iv. SMR is generally indicated for any traumapatient aged 65 or older.

T or Fv. SMR is generally indicated for any patient

who cannot stand up without assistance. T or F

a. Pupils and level of responsivenessb. Pulse and blood pressurec. Respiration

i. A patient who walks towards you when youarrive on the scene. or No

ii. A patient who cannot turn her head to look atyou as you approach.

or Noiii. A patient who was injured in a simple rear-

end motor vehicle collision. or No

iv.stairs. or No

v. A 61-year-old patient who is sitting on abench talking with a bystander. or No

Cervical

Thoracic

Lumbar

Sacrum

Coccyx

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Acute and Chronic Illnesses | 45

Acute and Chronic Illnesses



the insulin it does produce.

A chronic condition characterized by recurrent seizures.

A device used to measure a patient’s blood glucose level.

A condition in which too much sugar is in the bloodstream.

A condition in which too little sugar is in the bloodstream.

A hormone that enables the body to use sugar for energy; frequently used to treat diabetes.

A small portable device that provides continuous doses of insulin throughout the day.

A condition in which glucose in the blood is used up rapidly and there is not enough for the brain to function properly.

Diabetes that begins in childhood.

A disorder in the brain’s electrical activity, marked by loss of responsiveness and often uncontrollable muscle movement.

A continuous seizure or succession of seizures without a period of responsiveness.

known as fainting, blacking out, or passing out.



What Would You Do?

a. A diabetic emergency

c. Appendicitisd. Syncope

Move nearby objects out of the way, position the patient on his side if possible.

a. Clonicb. Aura

d. Tonic

b.normal

c. Until he is able to respond to painful stimulid. Until he enters the postictal phase

a. Give him water to drink

c. Not allow him to ingest anythingd. Get him to take his insulin

a. Give him more waterb. Have him take more insulin

d. Suspect it is not a diabetic emergency

Test Your Knowledge

i. Aura phase

ii. Tonic phase

iii. Clonic phase

iv. Postictal phase

a. Cincinnati scaleb. Pulse oximeter

d. There is no such device available to thegeneral public

b. The patient is likely to enter a diabetic comac. The patient is likely to develop tachypnea

and tachycardiad. The patient’s condition will gradually improve

over 5 to 10 minutes

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B Febrile A Characterized by brief, sudden loss of awareness; few or no convulsions

A Absence B Caused by a sudden increase in body temperature

C Status epilepticus C Lasts longer than 5 minutes or occurs repeatedly for more than 5 minutes

D Generalized D Has four distinct phases: Aura, tonic, clonic, and postictal

E Simple partial seizure E Involves convulsions in only one part of the body

b. Hypoglycemiac. Gastrointestinal (GI) bleedingd. Urinary tract infection

i. GI bleeding is caused by either blunt forcetrauma or a bacterial infection. T or F

ii. A patient with serious GI bleeding will oftenexperience tachycardia. T or F

iii. GI bleeding can occur in the upper or lowerGI tract.

T or Fiv. You must determine the cause of a patient’s

GI bleeding before determining whetherrapid transport is required. T or F

v. Serious GI bleeding can cause bloodpressure to drop sharply. T or F

b. When signs and symptoms do not start todisappear immediately after taking glucose

c. When the patient’s BGL is less than 4mmol/L

d. When the patient has insulin-dependentdiabetes

a. The patient should consider a reduced-sodium diet

c. The patient should increase the amount ofphysical activity in their routine

d. The patient should drink more water

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Poisoning | 48

Poisoning



A poison that enters the body through the skin or mucous membranes.

A group of substances used by law enforcement personnel to temporarily incapacitate groups of people.

A potent and illegal street drug formed from a medicinal substance whose chemical composition

Drug:

time and space; and produce delusions.

A poison that is swallowed.

A poison breathed into the lungs.

A poison that enters the body through a bite, sting, or syringe.

physical well-being.

Powerful depressant substances used to relieve anxiety and pain.

Any substance that causes injury, illness, or death when introduced into the body.


Poisoning | 49

A specialized health centre that provides information in cases of poisoning or suspected poisoning emergencies.

The deliberate, persistent, excessive use of a substance without regard to health concerns or accepted medical practices.

The use of a substance for purposes other than those intended by the manufacturer, or exceeding the recommended dosage.

What Would You Do?

a. Check for burns around the patient’s mouthand/or nose

c.d. Have a bystander try to wake the patient

while you gather supplies

a. An ingested poison

c. An absorbed poisond. An injected poison

a. Give the patient something to make himvomit

c. Move the patient into the open air andmonitor his condition for 5 to 10 minutes

d. Check the patient’s arms for signs of needlemarks

Test Your Knowledge

Liquid bleach

Carbon monoxide

Alcohol

Chlorine gas

Cocaine

Snakes

Heroin

Ticks

Powdered chemicals

Spiders

Poison ivy

Poison sumac

Animal bites

Giant hogweed

Toxic mushrooms

A

A

B C

D

C

B C

D

D

B

B

C

C

B

C

D

A

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Poisoning | 50

i. What type of poison was it?

ii. How did the contamination occur (inhalation,ingestion, etc.)?

iii. When did it occur?

iv. What was the quantity of poison (if known)?

b. The nearest hospital emergency departmentc. Law enforcement personneld. The nearest pharmacy

a. Ask any bystanders to help you restrain thepatient

c. Attempt to provide as much care to thepatient as possible

d. Try to determine which drug the patient hastaken

i. Carbon monoxide poisoning always occursquickly, resulting in unresponsiveness anddeath within an hour of exposure. T or F

ii. Carbon monoxide poisoning can cause lowblood pressure, headaches, and seizures. T or F

iii. Carbon monoxide is odourless, colourless,and tasteless.

T or Fiv. Carbon monoxide is produced naturally

during respiration. T or F

v. Prolonged exposure to carbon monoxide cancause red skin and lips.

T or F

a. Cover the patient’s eyes with a cool, dampcloth

b. Cover the patient’s eyes with dry dressingsand bandage them gently in place

d. Place the patient in the rapid transportcategory

a. An overdose of an injected drugb. Poisoning caused by an absorbed chemical

powderc. Exposure to a crowd management agent

• Sweating.• Nausea.•• Diarrhea.• Chest or abdominal

pain.• Dyspnea.

• Altered level ofresponsiveness.

• Seizures.

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Environmental Illnesses | 51

Environmental Illnesses



Heat transfer through direct contact with a solid or liquid.

Heat transfer through air or liquid moving across the skin.

Heat lost when liquid changes to a vapour.

and begins to freeze.

Painful spasms of skeletal muscles following exercise or work in warm or moderate temperatures; usually involve the calf and abdominal muscles.

A form of shock, often resulting from strenuous work or exercise in a hot environment.

A life-threatening condition that develops when the body’s cooling mechanisms are overwhelmed and body systems begin to fail.

A life-threatening condition in which the body’s warming mechanisms fail to maintain normal body temperature and the entire body cools.

The direct loss or absorption of heat energy through electromagnetic waves.



The apparent temperature in relation to the ambient temperature: A combination of wind speed and actual air temperature.

What Would You Do?

a. Heat cramps

c. Heat stroked. A heart attack

a. Heat crampsb. Heat exhaustion

d. Food poisoning

b. Mild hypothermiac. Moderate hypothermiad. A cold

a. Immerse the patient’s hands in cool (notcold) water until sensation returns

b. Run the patient’s hands under hot water(as hot as she can stand) for 5 minutes

d. Keep the patients’ hands from thawing untilshe can be examined by a physician

iii. Wrapping the patient’s hands in warm, moistdressings

v. Providing a small amount of warm brandy

vii.level of the heart

• Remove from heat• Loosen tight clothing,

remove padding fromtorso

• Do not dry skin• Pour water on torso• Fan skin• Provide a cool drink

• Move out of the heat• Rest

• Drink a cool beverage

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ix. Advising the patient to stay out of the colduntil the area has fully healed

Test Your Knowledge

i. Warm, moist skin, anxiety, dizziness

ii. Normal pulse, moist skin, headache

iii. Irritable, bizarre behaviour, severe headache

iv. Severe muscle contractions, normal mentalstate, warm skin

v. Dry skin, rapid respiration

iii. Severe muscle contractionsiv. Warm, moist skin

i. Age—particularly the elderly (especiallythose with dementia) and young children.

ii. Previous history of a heat- or cold-relatedillness.

iii. Respiratory or cardiovascular disease.

iv. Diabetes or other conditions that cause poorcirculation.

v. Taking medications to eliminate water fromthe body (diuretics).

a. Tachycardia and tachypnea

c. Tachycardia and bradypnead. Normal pulse and breathing

a. Take the patient’s temperature beforechecking for a pulse

c. Check for the patient’s pulse before checkingrespiration

d. Bring the patient into a warmer environmentbefore beginning the assessment

a. Has heat exhaustion

c. Has a pre-existing medical conditiond.

exposure

i. You should not attempt to swim to adrowning patient without special training.

T or Fii. You should not attempt to resuscitate a

patient who has been submerged for more than 10 minutes. T or F

iii. Any patient who survives a drowningincident should be assessed by a physicianimmediately.

T or Fiv. Most deaths in cold water are caused by

hypothermia, not drowning. T or F

v. The colder the water, the less chance thereis of resuscitating a drowning patient. T or F

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Pregnancy, Labour, and Delivery | 54

Pregnancy, Labour, and Delivery



A partial or complete detachment of a normally implanted placenta at more than 20 weeks’ gestation.

The rhythmic tightening of muscles in the uterus during labour; or, the pumping action of the heart.

The time during labour when the baby’s head begins to emerge from the opening of the vagina.

When a fertilized ovum implants anywhere other than in the uterus.

Labour: The birth process; beginning with the contraction of the uterus and dilation of the cervix and ending with the stabilization and recovery of the mother.

The spontaneous termination of pregnancy before 20 weeks of gestation.

An organ attached to the uterus and unborn child through which nutrients are delivered to the baby; it is expelled after the baby is delivered.

A condition in which the placenta is attached in the lower uterus.

Bleeding after the birth of a neonate; characterized by more than 500 mL (17 oz.) of blood loss.

A complication of childbirth in which a loop of umbilical cord protrudes through the vagina prior to delivery of the baby.

Bleeding during the last 3 months of pregnancy.

blood, nutrients, and waste.

A spontaneous or traumatic rupture of the uterine wall.



What Would You Do?

a pregnant woman who is due to go on maternity leave

a. She is experiencing Braxton Hickscontractions

b. She is experiencing an ectopic pregnancy

d. She is experiencing placenta previa

b. The placenta is being expelledc. The woman has had a miscarriaged. The baby is crowning

a. Transport the woman to the hospital

c. Pack the woman’s vagina with steriledressings

d. Tell the woman to try to delay the birth asmuch as possible

a. First

c. Thirdd. Fourth

The placenta is delivered.

b. Begin compression-only CPRc. Perform CPR at a ratio of 3:1 for 30 secondsd. Provide blow by supplemental oxygen at a

rate of 4 litres per minute

Test Your Knowledge

i. Preparation

ii. Delivery of the baby

iii. Delivery of the placenta

iv. Stabilization

As the baby moves through the birth canal, the cord will be compressed between the baby’s head

within a few minutes from lack of oxygen.

a. It aids in muscle relaxationb. It distracts herc. It ensures adequate oxygen for the mother

and baby

b. Begin ventilation using a neonate or pediatric

c. Continue with your assessment of theneonate

d. Treat the neonate for shock

b. Breech birthc. Placenta previad. Limb presentation

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a. Prolapsed cord

c. Placenta previad. Ectopic pregnancy

b. Pull gently on the baby’s shoulders as theyemerge to speed up the delivery

c.slow down the delivery, then unwrap thecord

d.

a. Begin chest thrusts and back blowsb. Flick the soles of the baby’s feet with your

d. Begin CPR at a rate of 3:1

a. Pack the vagina with sterile dressings andelevate the mother's legs

b. Massage the abdomen and have the motherassume a semi-sitting position

d. Have the mother assume the recoveryposition

b. Immediately before the baby is deliveredc. Approximately one hour after the delivery of

the babyd. During the fourth stage of labour

iii. Braxton Hicks contractions

vii. Spontaneous abortion (miscarriage)viii. Multiple births

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Special Populations | 57

Special Populations



thinking, and behaviour.

A condition in which a person has both a visual and a hearing impairment.

Impaired mental function, resulting from injury or genetics.

Partial or complete deafness.

Impaired mental function that interferes with normal activity.

A variety of injuries that may result when an infant or a young child is violently shaken.

The sudden death of a seemingly normal, healthy baby that occurs during the baby’s sleep without evidence of disease.

Inability to see adequately or at all; also referred to as blindness or partial blindness.



What Would You Do?

a. You should avoid asking for details about hispast medical history

b. You should ask about his oral intake for atleast the last 24 hours

c. You should ask whether he knows hisbaseline blood pressure

Chronic medical problems make it challenging to determine the baseline of illness. Complex medical history might include multiple conditions, surgeries, and medications.

i. Diabetes mellitus

ii. Hypertension

iii. Hyperlipidemia

Test Your Knowledge

i. Observe the child before touching him or her.

ii. When speaking to the child, lower yourself toeye level.

iii. Communicate clearly with the parent orguardian and the child.

iv. Remain calm

v. Keep the child with loved ones unless it isnecessary to separate them.

vi. Gain trust through your actions.

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Age Range

Things to Consider

Neonates

Infants

Toddlers

Preschoolers

School-aged Children

Adolescents 13 to 18

Abdominal muscles are used for respiration

Skin is thinner

Respiratory rate is higher



It is usually triggered by an acute viral infection.

It can quickly cause a life-threatening airway obstruction.

It typically causes a child to drool.

The condition may improve if the patient is exposed to cool air.

It is caused by a bacterial infection.

It requires the patient to be placed in the rapid transport category.

a. Stand directly in front of the patient so he orshe can see your shadow

b. Stay very quiet so the patient can hear whatelse is going on nearby

c. Speak loudly and enunciate every word sothe patient can hear you properly

a. To delay the death of the patient for as longas possible

b. To encourage the patient to move into ahospital for full-time care

c. To comfort the patient’s family and help themfeel they’re doing everything possible

b. Close the animal in another room or have abystander keep it out of sight

c. Keep the animal close and reassure theanimal by speaking calmly to it

d. Have a bystander keep the animal withinsight of the patient but at least 15 feet away

C

E

E

C

E

E

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Crisis Intervention | 61

Crisis Intervention



Abuse that may result in injury to the body.

Forcing another person to take part in a sexual act.

What Would You Do?

T or F

a. Have the woman wash herself so you cansee if there are any wounds that need care

b. Remove the woman’s clothing to check forother injuries

d. assault

b. Leave the area so she can have privacyc. Help her to change her clothes and wash her

faced. Look around for clues as to what happened

Test Your Knowledge

a. The patient’s physical injuriesb. The emotional state of the patient and any

bystandersc. Documenting everything you see for police

reports

a. Look for clues to determine whether thechild’s version of events is true

b. Ask the child’s caregiver(s) whether theywould like you to report the crime to police

c. Prevent anyone else from speaking to the

present

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Crisis Intervention | 62

a. Distract the patient by asking about topics ofgeneral interest

b. Attempt to convince the patient that life isworth living


a. Ask any bystanders to help you restrain thepatient

c. Leave the scened. Tell the patient that you will not provide care

until he or she calms down

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Reaching, Lifting, and Extricating Patients | 63

Reaching, Lifting, and Extricating Patients



A technique involving the placement of items, such as wooden blocks, against the wheels of a vehicle to help stabilize it.

Situation in which a patient is unable to exit a vehicle.

What Would You Do?

a. Accessing the patient so you can begin your

assessmentb. Stabilizing the vehiclec. Looking for any additional patients in and

around the vehicle

b. Break a window as far from the patient aspossible, open the door from the inside, andbegin caring for the patient

c. Break the driver’s window, open the doorfrom the inside, and begin caring for thepatient

d. Call a towing company or auto association tohelp you access the patient

Yes: The patient requires care for a life-threatening injury and you cannot provide it without moving her.

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Test Your Knowledge

i. Use your legs, not your back, to lift

ii. Keep the weight as close to you as possible

iii. Keep your body aligned

iv. Reduce the height or distance you need tomove

v. Use as many personnel as necessary

i. The scene becomes unsafe

ii. You must gain access to other patients

iii. You cannot provide proper treatment

i. Dangerous conditions at the scene

ii. The size of the patient

iii. Your own physical ability

iv. Whether others can assist you

v. The patient’s condition

i. Once an airbag has deployed it poses nofurther risk to responders. T or F

ii. The location of the airbags is the same fromone vehicle to the next. T or F

iii. Electronic devices that are plugged into thevehicle (e.g. cell phones) can cause powerfeedback, causing airbags to deploy.

T or Fiv. Even after disconnecting the battery and any

electronic devices in the vehicle, you shouldassume airbags are live and could deploy atany moment. T or F

v. You should always place a large, solid objectbetween yourself and an airbag deployment zone to reduce your risk if the airbag deploys unexpectedly.

b. Extremity liftc. Walking assistd. Any of the above

6

a. A patient has fainted in a narrow hallway andpeople are unable to get by

b. A patient is having a seizure in a shoppingmall and a crowd has gathered around

d. A patient is sitting on a busy sidewalk

chest pain

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T or F

5

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7

b. Instruct the patients to cover their facesbefore you break the window

c. Instruct one of the patients to break thewindow from the inside so the glass will bepushed out and away

d. Break a small hole in the window, pass PPEin to the patients, then break the rest of theglass once the patients have donned the PPE

8

Description

A long, rectangular metal or plastic frame with a wire mesh or plastic liner

A device used for transporting patients in a seated position

A rigid stretcher that can be separated into two pieces

A stretcher that can be lowered or raised manually using release handles (some may be powered electrically)

Two wooden poles with canvas or plastic stretched between them

A long, rigid board approximately 1.8 metres (6 feet) long

A device with no rigid structure of its own that can wrap around a patient

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Transportation | 66

Transportation



The right of a vessel or vehicle to cross in front of other vessels or vehicles.

Maintenance work that is planned and performed on a regular basis to ensure proper working order of equipment and/or vehicles.

In the direction from which the wind is blowing.

Test Your Knowledge

T or F

based on:a. Local protocolsb. Your speedc. Provincial/territorial motor vehicle laws

T or F

a. The type of call you are responding tob. Provincial/territorial motor vehicle lawsc. Local protocols

i.aircraft from the rear. T or F

ii. If an aircraft is landing at night you should

T or Fiii. If a helicopter has landed on an incline you

should approach from the downhill side. T or F

iv.all times when near an aircraft.

T or Fv. Once the aircraft has parked you should

approach with the patient immediately. T or F

• Follow all laws and acts with respect to the operation of an emergency vehicle in your province or territory.

• Follow all operational guidelines for your jurisdiction.

• Be observant and aware of other motorists and pedestrians.

• Always wear your seatbelt.

• Be familiar with the characteristics of the emergency vehicle.

• Be alert to changes in weather and road conditions.

• Exercise caution in the use of audible and visible warning devices.

• Drive within the speed limit, except in circumstances allowedby law.

• Maintain a safe following distance.

• Drive defensively, with due regard for the safetyof others.

• Adjust your driving to balance the needs of timely transportation,patient comfort, and road safety.

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Transportation | 67

i.

ii. High grass, crops, or other factors that canconceal uneven terrain or hinder access

iii. Debris


Multiple-Casualty Incidents | 68

Multiple-Casualty Incidents



Chemical, Biological, Radiological, Nuclear, Explosive. It is the general term used in Canada to refer to weapons of mass destruction (WMDs).

person.

A system used to manage resources, such as personnel, equipment, and supplies, at the scene of an emergency.

An emergency situation involving two or more patients.

Perimeter established 100 metres (328 feet) from the source of contamination (in an enclosed environment) or 900 metres (2,953 feet) from the source if it is outdoors.

Perimeter established beyond the inner perimeter to create a secure working area for responders and prevent unauthorized access to the contaminated area.

A simple system used at the scene of multiple-casualty incidents to quickly assess and prioritize care according to three conditions: respiration, circulation, and level of responsiveness.

The process of sorting and providing care to multiple patients according to the severity of their injuries or illnesses.

What Would You Do?

Clear the area of all those patients in the minor category

Dead/non-salvageable

The patient was not breathing and failed to breath after you attempted to open and clear the airway.



a. Black/greyb. Red

d. Greenb. Position the patient in a way that will maintain

an open airway and place a red tag on thepatient

c. Perform two cycles of CPR (30 compressionsand 2 breaths), then reassess the patient


Test Your Knowledge

Condition Triage Category

Sucking chest wound

Respiration: 60 breaths per minutePulse (radial): absentLevel of responsiveness (LOR): alert and oriented

Minor Delayed

Immediate Dead/non-salvageable

No apparent injuries

Respiration: 14Pulse (radial): presentLOR: alert and oriented

Minor Delayed Immediate Dead/non-salvageable

Impaled metal rod in left eye


Minor Delayed


No visible injuries Respiration: absent Pulse (radial): absent LOR: unresponsive

Minor Delayed Immediate


Skin moist and clammy;states he is diabetic

Respiration: 20Pulse (radial): absentLOR: alert and oriented

Minor Delayed


breathing; chest sinks in during inhalation


Minor Delayed


Amputated right arm;controlled bleeding

Respiration: over 32Pulse (radial): presentLOR: alert and oriented

Minor Delayed


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Condition Triage Category

Chest pain (sudden onset); breathing regular

Respiration: under 24Pulse (radial): presentLOR: alert and oriented


Head wound with brain matter visible

Respiration: absent Pulse (radial): absent LOR: unresponsive



30% full-thickness burns and50% partial-thickness burns

Respiration: absent Pulse (radial): present LOR: unresponsive



Pinned under pillar Respiration: under 20Pulse (radial): presentLOR: confused

Minor Delayed


Broken elbow Respiration: under 18Pulse (radial): presentLOR: alert and oriented


Bleeding scalp wound; facial abrasions; broken nose

Respiration: over 34Pulse (radial): presentLOR: confused

Minor Delayed


Compound femur fracture

Respiration: under 26Pulse (radial): absentLOR: alert and oriented

Minor Delayed


Impaled glass pane in abdomen

Respiration: under 20Pulse (radial): absentLOR: confused

Minor Delayed


Minor cuts and scrapes; injured ankle



Unable to move; no verbal response

Respiration: under 12Pulse (radial): presentLOR: awake but stares into space

Minor Delayed


Pregnant (8 months); abdominal pressure; urge to push; injured leg


Minor Delayed




a. Circulation

c. Level of responsivenessd. Respiration

a. Whenever two or more patients require caresimultaneously

b. Whenever two or more patients are injured ina CBRNE event

c. Whenever only one responder is available toprovide care

a. Femoral pulseb. Carotid pulsec. Brachial pulse

i. Establishing a common vocabulary for allparties involved.

ii. Creating an integrated communicationssystem.

iii. Establishing one commander who can makerapid, informed decisions.

iv.well-established divisions.

v. Creating easily managed units, normallyconsisting of no more than four people.

a. Look for the carotid pulseb. Check the patient’s level of responsivenessc. Colour-code the patient black or grey

a. Locate all the patients

c. Clear away all debris that could become ahazard

d. Care for anyone who has a life-threateningcondition

i. Attempting to open the patient’s airway

ii. Controlling external hemorrhaging

a. The patients’ level of responsiveness shouldnot be assessed

c. Patients with dyspnea should beautomatically placed in the immediate care category

d. Patients should be instructed to assessthemselves or one another, if possible

a. When there are more patients than there areresponders

b. When patients in a CBRNE event have

c. When patients within the security perimeterrequire care

a. From an uphill and downwind direction

c. From a downhill and upwind directiond. From a downhill and downwind direction

b. The incident commanderc. The local public health authorityd.

arrive

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Pharmacology | 72

Pharmacology



Physically introducing a medication into a patient’s body. This is a controlled act that is

special training.

What Would You Do?

to retrieve it from her purse on the other side of the

a. Place one of the pills in the patient’s mouthb. Place one of the pills in the patient’s handc. Open the bottle and hand it to the patient

a. Right person, right dosageb. Right time, right route

d. All of the Six Rights of Medication have beenmet

b.valid, current license

c.symptoms matches her presentation

d.be

a. The name of the physician who prescribedthe medication

b.Rights of Medication

c.medication bottle

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Pharmacology | 73

Test Your Knowledge assisting

( ) or administering ( ).

Opening the lid of a pill bottle

Placing pills in a patient’s hand

Opening an epinephrine auto-injector

Injecting a medication

Placing medication in a patient’s mouth

Unwrapping a transdermal patch

Reading a medication’s label aloud

Placing a transdermal patch on a patient’s skin

Pushing pills out of a blister pack

Spraying medication into the patient’s nose

1. Right Person

2. Right

3. Right Dosage

4. Right

5. Right

6. Right

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