Emergency Preparedness and First Aid

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

43Emergency

Preparedness and First Aid


43-2

Learning Outcomes

43.1 Discuss the importance of first aid during a medical emergency.

43.2 Describe the purpose of the emergency medical services (EMS) system and explain how to contact it.

43.3 List items found on a crash cart or first-aid tray.

43.4 List general guidelines to follow in emergencies.


43-3

Learning Outcomes (cont.)

43.5 Compare various degrees of burns and their treatments.

43.6 Demonstrate how to help a choking victim.

43.7 Demonstrate cardiopulmonary resuscitation (CPR).

43.8 Demonstrate four ways to control bleeding.

43.9 List the symptoms of heart attack, shock, and stroke.


43-4

Learning Outcomes (cont.)

43.10 Explain how to calm a patient who is under extreme stress.

43.11 Discuss ways to educate patients about ways to prevent and respond to emergencies.

43.12 Describe your role in responding to natural disasters and those caused by humans.


43-5

Introduction

• Emergencies– Acute illnesses

– Acute injuries

– Phone calls from patients with urgent problems

– Disasters

The medical assistant must be prepared to determine the urgency of and handle any emergencies that

arise


43-6

Understanding Medical Emergencies

• Any situation in which a person becomes ill or sustains an injury requiring immediate care

• Prompt action may prevent disability or death

• Can occur within or outside the health-care setting


43-7

Understanding Medical Emergencies • Quick response using

first aid is vital

• First aid can– Save a life– Reduce pain– Prevent further injury– Reduce risk of

permanent disability– Increase the chance

of early recovery

• Patient education – First aid– Proper way to respond

in an emergency


43-8

Apply Your Knowledge

Why is it important to perform first aid in a medical emergency?

ANSWER: First aid can: Save a life Prevent further injury Reduce pain Reduce risk of permanent disability Increase the chance of early recovery


43-9

Preparing the Office for Emergencies• Establish roles

• Post emergency telephone numbers – EMS if different than 911– Fire– Police – Poison control

• Crash cart – rolling cart with emergency supplies and equipment

– Women’s shelter– Rape hotline– Drug and alcohol

center


43-10

Preparing the Office (cont.)

• Provide information to EMS– Your name and location– Nature of the emergency– Number of people needing help– Condition of the injured or ill patient(s)– Summary of the first aid already given– Directions to your location

Do not hang up until the dispatcher gives you permission to do so.


43-11

Preparing the Office (cont.)

• Emergency and first-aid supplies– Crash cart/tray

• Basic drugs, supplies, and equipment for medical emergencies

• First-aid kit for minor injuries and ailments

– Must be routinely checked and restocked


43-12

Guidelines for Handling Emergencies

• A medical emergency requires certain steps– Medical assistant provides only first aid

• Patient emergencies– Assess the situation– PPE– Assess patient

• Six steps to initial assessment1. General impression2. Level of responsiveness3. Assess ABCs

4.Urgency of condition5.Focused exam 6.Document


43-13

Handling Emergencies (cont.)

• Telephone emergencies– Triaging

• Classification of injuries according to severity, urgency of treatment, and place for treatment

• Follow office protocols

– General guidelines• Stay calm• Reassure the patient• Act confidently in an organized manner


43-14


• Personal protection– Take precautions to reduce chance of

exposure during an emergency

– Follow Standard Precautions

– Keep personal protective equipment in first-aid kit at home and work


43-15


• Documentation– Assessment

– Treatment given

– Patient response

– If patient transported, location of facility

– Date, time

– Signature, credentials


43-16


What are the steps of the initial assessment of a patient in an emergency?

ANSWER: The steps of the initial assessment are: 1. Form a general impression of the patient2. Determine the patient’s level of responsiveness3. Assess ABCs4. Determine the urgency of condition5. Perform a focused exam (head to toe); vital signs; skin

color6. Document findings/report to physician or EMT

Correct!


43-17

Accidental Injuries

• Injuries requiring emergency treatment

– Bites and stings– Burns– Choking– Ear and eye traumas– Falls and fractures– Head injuries


43-18

Bites and Stings• Animal bites

– Bruise, tear, or puncture

– Cleanse wound, apply ointment and dry, sterile dressing

• Insect stings– Remove stinger, if

present– Wash area, apply ice

• Snake bites– Poisonous bite will

need antivenin – Immobilize and

position below heart

• Spider bites– Refer patient to

physician– Wash area, apply ice,

and keep below heart level


43-19

Burns• Thermal

– Hot liquids, steam, flame, etc.

– Water, wet cloth, or blanket

• Chemical – Remove chemical– Wash with cool water

for 15 minutes– Cover with dry, sterile

dressing

• Electrical– Entry and exit sites– Tissue damage along

current’s pathway


43-20

Burns (cont.)

• Classifications of burns– Severity determined by

• Depth and extent of burn area• Source of burn• Age of patient• Body area burned• Other illness/injuries

– Categories • Minor • Moderate• Major


43-21

Burns (cont.)

• Classifications of burns– By depth

• Superficial• Partial-thickness• Full-thickness

– Estimation of extent of a burn using rule of nines


43-22

Choking

• Foreign object or food blocks the trachea or windpipe

• Universal sign– Hand up to throat with a fearful

look

Medical assistants should know first aid for choking adult, child, or infant!


43-23

Accidental Injuries (cont.)

• Ear trauma– Lacerations, cuts– Severed ear – wrap

ear and transport with patient

• Eye trauma– Falls, blows to eye,

puncture, foreign objects

– Care depends on severity

• Falls – Have patient

examined before moving

– Stabilize neck if injury suspected

– Minor falls, notify the physician; document


43-24

Fractures and Dislocations

• Fracture – break in the bone

• Dislocation – displacement of a bone end from the joint

• Sprain – partial tearing of ligaments

• Strain – muscle injury occurring from overexertion

• Treatment– Immobilize – Ice – Monitor patient


43-25

Head Injuries

• Concussion – jarring injury of the brain– Patient may lose consciousness, have temporary loss

of vision, pallor, listlessness, memory loss, or vomiting

• Severe head injuries – contusions, fractures, and intracranial bleeding– May require immediate hospitalization and/or CPR

• Scalp hematoma and laceration – blood under the skin or break in the skin– Control swelling with ice– Control bleeding with direct pressure


43-26

Hemorrhaging

• Heavy or uncontrollable bleeding– Internal – keep patient warm,

quiet, and calm, and get medical help

– External• Use direct pressure, apply

additional dressing as needed• Elevate body part, put pressure on nearest

pressure point between wound and heart


43-27

Multiple Injuries

• Often the result of automobile accident or fall

• Assess ABCs, perform CPR if needed– Only perform first aid after ABCs ensured– Treat most life-threatening injuries first

• Notify EMS/physician


43-28

Poisoning

• Substance that produces harmful effects if it enters the body

– Majority of accidental poisonings happen in children under age 5

– Post poison control center number

– Patient education – prevention


43-29

Poisoning (cont.)

• Ingested poisons– Only induce vomiting if directed – Position patient on left side– Send poison container with patient

• Absorbed poisons– Remove contaminated

clothing– Wash skin, alcohol,

rinse

• Inhaled poisons– Get to fresh air– Loosen clothing– Check ABCs


43-30

Weather-Related Injuries• Hypothermia

– Body temperature below 95º

– Move patient inside, cover with blankets, give warm liquids

• Frostbite– Ice crystals form

between tissue cells– Warm with clothing or

other body part

• Heat stroke– Prolonged exposure to

high temperatures and humidity

– Move to cool place, cool with whatever is available

• Sunburn – Soak in cool water,

cold compresses


43-31

Open Wounds

• Skin or mucous membrane is damaged

• Incisions and lacerations– Control bleeding– Clean and dress

wound

• Abrasion – Wash with soap and water– Remove debris, dressing

if needed

• Amputations– Elevate extremity– Transport body part

with patient

• Punctures – Clean, dress– Tetanus toxoid

immunization


43-32

Closed Wounds

• Injury occurring inside the body without breaking the skin

• Caused by blunt trauma

• Contusions – bruises – Cold compresses – Color changes are normal


43-33


ANSWER: The patient holds his hand to his throat and looks afraid.

1. What is the universal sign of choking?

2. A patient arrives at the clinic with severe hemorrhaging from the left thigh. What steps should you take to control the bleeding?

ANSWER: The steps are: 1. Apply direct pressure with sterile gauze 2. Add additional dressing as necessary3. Elevate the leg4. Apply pressure to the left femoral artery

Yeah!


43-34

Common Illnesses

• Abdominal pain – a variety of causes

• Asthma – spasmodic narrowing of bronchi

• Dehydration – lack of adequate water in the body

• Diarrhea – can result in dehydration and electrolyte imbalance


43-35

Common Illnesses (cont.)

• Fainting (syncope) – partial or complete loss of consciousness

• Fever – usually indicates infection

• Hyperventilation – breathing too rapidly and too deeply

• Nosebleed – epistaxis

• Tachycardia – heart rate greater than 100 bpm

• Vomiting – can result in dehydration and electrolyte imbalance


43-36


Matching:

___ Syncope A. Nosebleed

___ Pulse > 100 bpm B. Fainting

___ Spasmodic narrowing of bronchi C. Dehydration

___ Dehydration and electrolyte imbalance D. Tachycardia

___ Epistaxis E. Diarrhea/vomiting

___ Rapid and deep breathing F. Asthma

___ Lack of adequate water G. Hyperventilation

ANSWER:

G

F

E

D

C

B

A


43-37

Less Common Illnesses

• Anaphylaxis – Severe, life-threatening allergic reaction– Check ABC’s, perform CPR if needed

• Bacterial meningitis – usually a complication of another bacterial infection

• Diabetic emergencies – Insulin shock – severe hypoglycemia – Diabetic coma – severe hyperglycemia


43-38

Less Common Illnesses (cont.)

• Gallbladder attack – inflammation of the gallbladder due to obstruction of cystic duct

• Heart attack – Myocardial infarction– Chest pain –

cardinal symptom– Cardiac arrest –

ventricular fibrillation

• Hematemesis – vomiting blood

• Obstetric emergencies – office protocols

• Respiratory arrest– May follow distress– Assess ABCs, perform

CPR, if needed


43-39

Less Common Illnesses (cont.)

• Seizures – Convulsions– Patient safety a

priority

• Shock – Life-threatening

state related to failure of the cardiovascular system

– Hypovolemic shock

– Septic shock

• Stroke – cerebrovascular accident due to impaired blood supply to brain

• Toxic shock syndrome – acute bacterial infection originating in the uterus

• Viral encephalitis – inflammation of the brain due to a virus


43-40

CPR• Provides ventilation and

circulation for an arrest victim

• Assess responsiveness, call EMS (911)

• Assess ABCs

• If available, connect patient to the automated external defibrillator (AED)

• Start CPR


43-41


Matching:

___ Hypo- or hyperglycemia A. Stroke

___ Myocardial infarction B. Diabetic emergencies

___ Vomiting blood C. Seizures

___ Impaired blood supply to brain D. Hematemesis

___ Convulsions E. Shock

___ May be hypovolemic or septic F. Heart attack

F

E

D

C

ANSWER:

B

A

SUPER!


43-42

Common Psychosocial Emergencies

• Alcohol, spousal, child, and elder abuse– Report per state law– Provide information on

community resources

• Overdose on drugs– Requires emergency

care– Call EMS

• Violent behavior– Office protocols– Document


43-43

Common Psychosocial Emergencies (cont.)

• Suicide– Allow patient to

verbalize– Report suspicions to

physician– Always take patient

seriously

• Rape – Provide privacy– Contact authorities

and local rape hotline– Follow protocol for

chain of custody of specimens


43-44


Mrs. Jamison tells you that she is very tired of being ill and often thinks of “ending it all.” She then laughs and says she was just kidding. What is/are your responsibilities in this matter?

ANSWER: You should allow her to talk about her feelings and despite the fact that she said she was “just kidding” you should take her seriously. The physician should be told of her comments. You may be asked to provide her with information on community services available. You should document her comments and your actions.


43-45

The Patient Under Stress

• People react differently to emergency situations

– Detect stress• Behavior different

from normal• Unable to focus or

follow directions

• Keep victims and family calm

• Challenges – Non-English speaking– Visual impairments – Hearing impairments


43-46

Educating the Patient • How to prevent and handle medical

emergencies

• Encourage patients and families to learn first aid and CPR

• Provide first-aid kit checklist

• How to access EMS and to keep emergency numbers by the phone

• How to childproof homes

• Provide appropriate, easy-to-read handouts


43-47


True or False:

___ All people react the same during an emergency.

___ Patients should be encouraged to learn CPR and first aid.

___ Challenges to dealing with patients during an emergency include visual and hearing impairments and English- speaking people.

___ Patients should be instructed on how to prevent emergencies.

___ It is not important to keep the victim of an emergency calm.

ANSWER:F

F

F

T

T

differently

non- Very Good!


43-48

Disasters

• Be familiar with standard protocols for responding to disasters

• Participate in fire or other disaster drills to familiarize yourself with emergency procedures

• Triage –victims are tagged to classify the victim

–Emergent – needing immediate care–Urgent – needing care within several hours–Nonurgent –needing care when time is not critical, or dead


43-49

Disasters (cont.)

• Evacuation plans – maps of facility with escape routes

• Shelter-in-place plans –interior room with few/no windows

• Plans– Communication during and after emergency– Training in procedures and employee roles– Means of alerting employees


43-50

Disasters (cont.)

• Weather-related– Community command

post– Accept assignments

appropriate to abilities– Document carefully

• Office fires– Activate alarm system– Fire extinguisher– Turn off oxygen– Close windows and

doors– Evacuate


43-51

Disasters (cont.)

• Bioterrorist attack – Be alert for an

increased incidence of disease

– Take isolation precautions

– Use Standard Precautions

– Inform local health departments

• Chemical emergency– Use PPE– Identify the chemical;

report to local authorities

– Assist with decontamination

– Monitor patient– Document patient care– Arrange for patient

transport


43-52

Disasters (cont.)

• Mass casualties– Assess safety– Report to community

command post– Triage – Provide first aid– Document care


43-53

Bioterrorism

• Intentional release of a biologic agent with the intent to harm individuals

• Biologic agent = weapon–Easy to disseminate–High potential for mortality–Cause public panic or social disruption–Requires public health preparedness


43-54

Bioterrorism (cont.)

• Physician’s offices are the front lines –Individual cases

–Common trends in syndromes/unusual patterns

• Notify local public health department of suspected cases

• Follow state and national guidelines


43-55


1. What are the categories for triaging patients?

ANSWER: They are: emergent – needing immediate care; urgent – needing care within several hours; nonurgent – needing care when time is not critical, or dead

2. What criteria does a biologic agent have to meet to be a biological weapon?

ANSWER: It must be easy to disseminate, have a high potential for mortality, cause public panic, and require public health preparedness.


43-56

In Summary

43.1 Prompt and appropriate first aid can safe a life, reduce pain, prevent further injury, reduce the risk of permanent disability, and increase the chance of early recovery.

43.2 An EMS system is a network of qualified emergency services personnel who use community resources and equipment to provide emergency care to victims of injury or sudden illness. In most parts of the country, the EMS system number is 911.


43-57

In Summary (cont.)

43.3 The crash cart should include all appropriate drugs, supplies, and equipment needed for emergencies. These include but are not limited to activated charcoal, atropine, dextrose 50%, epinephrine, lactated Ringer’s solution, nitroglycerin tablets, and sodium bicarbonate.

43.4 When faced with an emergency, a medical assistant should first assess the surroundings to determine if the area is safe. If the area is safe, the medical assistant should don appropriate PPE and do an initial assessment of the patient.


43-58

In Summary (cont.)

43.5 The severity of a burn is determined by the depth and extent of the burn area, the source of the burn, the age of the patient, the body regions burned, and other patient illnesses and injuries. The depth and extent of the burn determines the type of treatment.

43.6 The goal of rendering first aid to a choking victim is to restore an open airway. This is accomplished by providing abdominal thrusts or chest thrusts until the object is expelled.


43-59

In Summary (cont.)

43.7 The essential steps of CPR include opening the airway, giving 2 breaths of about 1 second each, delivering 30 chest compressions, hard and fast, following by 2 breaths, continuing until the patient recovers, help arrives, or you are too exhausted to continue.

43.8 Severe bleeding may be controlled by applying direct pressure to the wound, applying pressure over the nearest pressure point, elevating the injured body part, or, as a last resort only, applying a tourniquet.


43-60

In Summary (cont.)

43.9 The symptoms of heart attack include chest pain, pain in the left arm, or pain in the neck and jaw, pallor, shortness of breath, sweating, nausea, and vomiting. The symptoms of shock include restlessness, irritability, fear, rapid pulse, and increased respiratory rate. The symptoms of stroke include headache, confusion, dizziness, speech difficulties, weakness of the limbs or paralysis on one side of the body, and loss of consciousness.

43.10A medical assistant can help calm a patient by listening carefully and giving her or his full attention.


43-61

In Summary (cont.)

43.11Medical assistants should educate patients about ways to prevent and handle various medical emergencies by providing brief, easy-to-read handouts containing local emergency contact numbers and a first-aid kit checklist. The handouts should be prepared in multiple languages if the practice provides care for non-English-speaking patients.

43.12During a disaster, a medical assistant’s first-aid and CPR training will be of enormous help. A medical assistant must also be familiar with standard protocols for responding to disasters.


43-62

End of Chapter 43

In the sick room, ten cents' worth of

human understanding equals

ten dollars' worth of medical science.

~ Martin H. Fischer

Emergency Preparedness and First Aid

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