REFRESHER ON MEDICAL EMERGENCIES
You are watching your 8 year old son playing little league baseball and in the middle of the game the pitcher is knocked over with a ball right to his chest. Will you know what to do? Many of us, everyday, are witness to trip and fall accidents, car crashes and other medical emergencies. This course will serve as a refresher course on what a first responder is, how are they protected, what constitutes a medical emergency, what to do for many common emergencies, how medical emergencies should be transported, advice on psychological trauma and the emotional toll on responders, themselves.
Information in this course is designed as a refresher course, not a recommendation or full training, and is not meant to usurp medical training or personal judgment.
A certified first responder is a person who has completed a course, through a recognized organization such as the American Heart Association or Red Cross and have received certification in providing pre-hospital care for medical emergencies. They have more skill than someone who is trained in basic first aid but they are not a substitute for advanced medical care rendered by emergency medical technicians, emergency physicians, nurses, or paramedics. The term “certified first responder” is not to be confused with “first responder”, which is a generic term referring to the first medically trained responder to arrive on scene (police, fire, EMS). Without being too concerned with titles, it is important for anyone who is willing to help in an emergency. The help may be with keeping the victim calm, calling 911 or initiating Cardio Pulmonary Resuscitation (CPR).
Many people who do not fall into the category of medical technicians, emergency physicians, nurses, or paramedics seek out or receive Certified First Responder training through their employment because they are likely to be first on the scene of a medical emergency, or because they work far from medical help.
Some of these non-traditional first responders include:
Designated industrial workers in a large facility (industrial plant) or at a remote site (fish-packing plant, commercial vessel, oil rig)
Search and rescue personnel
Campus Responders and campus police
Community Emergency Response Team (CERT) members (varies by jurisdiction).
It is critical to know how to recognize the signs of a medical emergency. Correctly interpreting and acting on these signs could make a real difference in a true emergency. Many people under report the symptoms of an medical emergency, such as a heart attack or stroke. They sometimes want to see if the symptoms will go away on their own. They delay seeking care right away out of denial, fear, financial concerns or for a myriad of other reasons. For many medical emergencies, time is of the essence, and delays in treatment can often lead to more serious consequences.
Emergency physicians believe it is the responsibility of every individual to learn to recognize the warning signs of a medical emergency. The following signs and symptoms and are not intended to represent every kind of medical emergency, but rather to provide examples of common issues.
The following is refresher information on a how to handle common emergency medical conditions. This section does not contain all the signs or symptoms of medical emergencies, and the advice is not intended to be a substitute for consulting with a medical professional specializing in the symptoms the victim is reporting. Someone who is experiencing a medical emergency should seek immediate medical attention.
Side effects are a normal occurrence with many drugs. Some are minimal and some can be very serious and can trigger life-threatening reactions both allergic and non-allergic. Also, some medicines interact with other medications and cause adverse drug reactions. An adverse drug reaction is an expression that describes harm associated with the use of given medications at a normal dose. People who take three or four medications each day are more likely to have reactions to drugs. In addition, the use of herbal supplements and alternative medicines can interact with certain drugs and cause health issues.
Adverse drug reactions can occur within minutes or within hours of exposure. They are a leading cause of death in the United States, resulting in more than 100,000 deaths each year.
The most common symptoms of allergic reactions to drugs are:
Skin rash or hives
- Itchy skin
- Wheezing or other breathing problems
- Diarrhea or constipation
Penicillin is a frequent culprit for adverse drug reactions. Antibiotics, sulfa drugs, barbiturates, and insulin also can cause problems. Some medicines trigger a response from the immune system in people with drug hypersensitivity. The body’s immune system perceives the substance as attacking the body, so it attacks the system.
More than 90 percent of adverse drug reactions do not involve an allergic immune system response. Instead, these reactions may produce a range of symptoms involving almost any system or part of the body – which often makes them difficult to recognize.
Reactions to drugs may range from mild, such as upset stomach or drowsiness, to severe, life-threatening conditions, such as anaphylaxis. These reactions can occur with prescription medications, over-the-counter medications and supplements or herbal remedies.
Everyone with known sensitivity should always tell their doctor if they have adverse reactions to medications and they should wear an identifying bracelet or jewelry that alerts rescuers to their condition.
Although asthma and allergies are two separate conditions – asthma is a chronic disease of the bronchial airtubes, whereas allergies involve an overreaction of the body’s disease-fighting immune system – the two conditions can be intertwined and often overlap.
For example, because most people with asthma also have allergies, asthma attacks, sometimes referred to as “exacerbations”, can be triggered by exposure to allergens, such as pollen, mold or animal dander. This type of asthma is known as allergic asthma, and it is one of several types of asthma.
In addition, asthma and certain allergic conditions, such as hay fever and peanut allergy, share the potential to be life threatening. Allergies can be life-threatening when they lead to anaphylaxis. Asthma can be fatal when a severe asthma attack does not respond to inhaled bronchodilators and leads to symptoms of respiratory failure, a condition known “status asthmaticus.”
Finally, since many of the symptoms of asthma are the same as they are for allergies, physicians may use some of the same medications to treat both.
Asthma is a chronic lung disease that results in 1.8 million emergency visits and about 4,000 deaths each year. There are several types of asthma, and although the disease can be controlled, there is not yet a cure, which means that asthma patients must manage their condition on a daily basis. Moreover, it is estimated that about half of asthma sufferers do not have their condition under control, making it more likely that these patients will end up in an emergency department as a result of an asthma attack. When poorly controlled, asthma is potentially life-threatening.
The characteristics of asthma include inflammation (swelling and irritation) of the airways and broncho constriction (tightening of the muscles surrounding the airways). Often worse at night, these problems shrink the airways, making it more difficult to breathe. The often-missed warning signs of poorly controlled asthma are:
- Waking at night wheezing and/or coughing
- Requiring a quick-relief inhaler more than twice a week
- Missing school or work
- Being unable to participate in everyday activities
- Requiring emergency or urgent care in order to breathe properly
Respiratory infections, such as the common cold or flu, are common triggers of asthma exacerbations, (which is why persons with asthma are advised to get a flu shot each fall when the vaccine becomes available). Other triggers include exercise, laughing or crying hard, cold air and irritants, such as poor air quality (e.g., Code Red ozone pollution days in the summer), chemicals, smoke, perfume and air fresheners. Some allergens also can serve as triggers. Common inhaled allergens include dust, pollen, mold or animal dander.
The symptoms of asthma include:
- Tightness in the chest
- Coughing and wheezing
Asthma attacks that appear to be severe or that do not respond to the patient’s normal medication require immediate medical attention. Less serious attacks or an increasing frequency of asthma attacks should be evaluated by a visit to one’s doctor. In some cases, the patient may seek the advice of an asthma care specialist – such as an allergist or pulmonologist.
Asthma patients should go to the emergency department if they have severe asthma symptoms, especially if these symptoms are accompanied by severe sweating, faintness, nausea, panting, rapid pulse rate, and pale, cold, moist skin. (These may be signs of shock or a potentially life-threatening drop in blood pressure.) These patients may be experiencing a potentially fatal asthma attack, known as “status asthmaticus.”
Seek immediate medical attention for the following symptoms and warning signs associated with this potentially life-threatening condition:
Persistent shortness of breath or breathlessness experienced even while lying in bed.
- An asthma attack that is not relived by a usually effective rescue inhalers.
- Lips or fingernails are turning blue (or gray in persons with dark complexions).
- Straining to breathe or the inability to complete a sentence without pausing for breath.
- A feeling of chest tightness.
- Feelings of agitation, confusion or an inability to concentrate.
- Hunching of shoulders, straining of abdominal and neck muscles or sitting or standing to breathe more easily
These are all signs of impending respiratory system failure, a potentially fatal condition. Be aware also that fatal asthma attacks often occur with few warning signals, and that they can come on quickly, leading rapidly to asphyxiation and death. Fatal asthma attacks are more common among persons who have poor control of allergens or asthma triggers in their daily environments and an infrequent history of using peak flow monitors and inhalers as aids in controlling their asthma.
Finally, it is important to note that extremely severe, potentially fatal asthma attacks may not feature more wheezing and coughing – thus making such symptoms unreliable in judging the severity of asthma attacks. In such cases, the breathing airways have become so restricted that there is not enough air going in and out of the lungs to cause wheezing or coughing. In addition, wheezing also can be a sign of other health conditions, such as respiratory infection and heart failure, so it is important to seek prompt medical attention if these other serious conditions are suspected.
Emergency department treatment of asthma typically includes oxygen, inhaled bronchodilators (such as albuterol), and systemic corticosteroids (such as prednisone). Long-term asthma treatment includes inflammation “controllers,” such as inhaled corticosteroids, and symptom “relievers” such as inhaled bronchodilators.
Since the key to preventing asthma attacks is controlling them, it is important to seek out proper medical care, take medication as directed and become educated as to how best avoid previously described “asthma triggers.”
Allergies involve an overreaction of the body’s immune system, which is responsible for fighting infections. There are many types of allergies, including seasonal allergies, which involve allergic reactions to pollens, grasses and weeds, perennial allergies, which last for 9 or more months out of the year, chronic allergies to allergens such as dust and mold, food allergies, medicine allergies, insect venom allergies, and animal allergies, among others. In addition, some people develop a potentially life-threatening allergy to latex, which is found in rubber gloves, while others can become “sensitized” to substances they have been repeatedly exposed to at work, a condition known as “occupational allergy.”
Allergic responses range from mild to life threatening. Common mildly annoying allergy symptoms include sneezing, congestion, runny nose, watery eyes, headache and fatigue. However, exposure to some allergens, such as peanuts, shellfish, insect stings, medications, and latex can quickly progress to severe life-threatening reactions or anaphylaxis. For that reason, seek emergency care right away if you experience a mix of some of the following symptoms:
- Wheezing (along with high-pitched breathing sounds)
- Anxiety, fear, apprehension
- Slurred speech
- Swelling of the face, eyes, tongue or extremities
- Trouble swallowing
- Severe sweating
- Faintness, lightheadedness, dizziness
- Heart palpitations (feeling one’s heart beat)
- Nausea and vomiting
- Abdominal pain, cramping
- Rapid or weak pulse rate
- Pale, cold, moist skin or skin redness
- Blueness of skin, including lips or nail beds (or grayish for darker complexions)
- Loss of consciousness
Additional Precautions and Prevention
Individuals with allergies and asthma, which as noted earlierare often related, should always carry medications with them and ask their doctors about wearing medical alert bracelets or jewelry.
More specifically, individuals with asthma should always carry a quick-relief inhaler (bronchodilator), such as albuterol, and avoid known asthma triggers when possible. Individuals at risk of anaphylaxis, for whom a doctor has prescribed self-injectable epinephrine (such as an EpiPen or TwinJect), should carry it at all times and know how to use it in an emergency. If you are helping someone having an asthma attack you might have to get the inhaler for them.
Injectable epinephrine should not be used on persons other than the person for whom it has been prescribed (e.g., asthmatics or persons allergic to insect venom). Some people may have underlying health conditions that could be adversely affected by this drug. If the individual you are helping is having difficulty with their injectable, in many states, it is illegal for you, unless you are licensed to administer prescription medications, to inject them with a prescription medication, you can however assist them by getting the device for them or assisting them with them giving it to themselves. Under new American Heart Association and American Red Cross first-aid guidelines, first-aid providers may help victims who are experiencing a bad anaphylactic reaction use a prescribed epinephrine auto-injector – as long as the first-aid provider is trained to do so, the state law allows it and the victim is unable to self-administer the epinephrine, however it is best to simply assist them in giving it to themselves unless you have received specific training and know your state laws.
Anaphylaxis is a severe, life-threatening, multisystemic allergic reaction that is triggered by common substances, such as foods, insect stings, medications and latex.
About half of all anaphylaxis episodes are caused by such foods as peanuts, tree nuts (e.g., walnuts, pecans, almonds and cashews), fish, shellfish, cow’s milk and eggs. Bees, wasps, hornets, yellow jackets and fire ants are the cause of about 500,000 allergy-related emergency visits and at least 50 deaths each year. Medications can cause anaphylaxis, particularly drugs in the penicillin family. Other commonly used medications and pain relievers that can trigger anaphylaxis include aspirin, ibuprofen, anesthetics and antibiotics. People who have had one or more previously mild episodes of anaphylaxis may be at risk for more severe future episodes. Repeat exposure to allergens, such as latex, may also increase the risk of developing anaphylaxis.
Anaphylaxis symptoms can develop quickly, in some cases within minutes or hours after exposure to an allergen. In some cases, the symptoms can abate and then return hours later. The most dangerous symptoms of anaphylaxis affect the respiratory system (breathing) and/or cardiovascular system (heart and blood pressure). Specific symptoms may include:
Difficulty breathing due to narrowing of airways and swelling of the throat
Wheezing or coughing
Unusual (high-pitched) breathing sounds
Swelling of the tongue, throat and nasal passages (nasal and throat congestion)
Localized edema (or swelling), especially involving the face
Itchiness and redness on the skin, lips, eyelids or other areas of the body
Skin eruptions and large welts or hives
Bluish skin color, especially the lips or nail beds (or grayish in darker complexions)
Nausea, stomach cramping, vomiting/diarrhea
Heart palpitations (feeling the heart beating)
Weak and rapid pulse
Drop in blood pressure
Dizziness, fainting or loss of consciousness, which can lead to shock and heart failure.
If you see someone with the symptoms of anaphylaxis it is important to take action quickly. You can respond by:
If the person is having anaphylaxis, call 911 immediately.
If the person is unconscious, lay him or her flat and elevate the feet.
If available, help the victim get their or help them administer self-injectable epinephrine (e.g., EpiPen, TwinJect), which should be carried by all persons who know they are at risk for anaphylaxis. As noted earlier, under new American Heart Association and American Red Cross first-aid guidelines, first-aid providers may help victims who are experiencing a bad anaphylactic reaction use a prescribed epinephrine auto-injector – as long as the first-aid provider is trained to do so, the state law allows it and the victim is unable to self-administer the epinephrine. However it is know your individual state laws. Also, check for a medical tag, bracelet or necklace that may identify anaphylactic triggers.
Cardio-Pulmonary Resuscitation (CPR)
Cardio-Pulmonary Resuscitation (CPR) saves lives. CPR is a combination of rescue breathing and chest compressions delivered to victims thought to be in cardiac arrest. When cardiac arrest occurs, the heart stops pumping blood. CPR can support a small amount of blood flow to the heart and brain to buy time until normal heart function is restored. Quick response is crucial to a positive outcome. CPR should be started within 3 minutes of when the heart stops pumping.
The tips provided below are based on procedures recommended by the American Heart Association (AHA) and are not a substitute for formal training in CPR. Everyone with the ability to move the chest wall should take a course and should have their CPR skills tested at least every two years.
The use of Automated External Defibrillators (AEDs) go hand in hand with CPR. Rescuers, both professional and lay, can be trained to operate these small, portable, computerized devices used to apply electric shock to restart a heart that has developed a chaotic rhythm called ventricular fibrillation, the most common cause of sudden cardiac arrest. Survival is directly linked to the amount of time between the onset of sudden cardiac arrest and the treatment with an electric shock to stop the abnormal heart rhythm. There is a major push for public access to these devices.
To perform CPR remember the ABCs of CPR: Airway, Breathing, and Circulation. This acronym is used to help you remember the steps to take when performing CPR.
- If a person has collapsed, determine if the person is unconscious. Gently prod the victim and shout, Are you okay? If there is no response, shout for help. If someone is available ask them to call 911 or your local emergency number and go get an AED if one is nearby.
- Open the persons airway by lifting up the chin gently with one hand while pushing down on the forehead with the other to tilt the head back. If the person may have suffered a neck injury, in a diving or automobile accident, for example, open the airway using the chin-lift without tilting the head back. If the airway remains blocked, tilt the head slowly and gently until the airway is open.
- Once the airway is open, check to see if the person is breathing.
- Take five to 10 seconds (no more than 10 seconds) to verify normal breathing in an unconscious adult, or for the existence or absence of breathing in an infant or child who is not responding.
- If opening the airway does not cause the person to begin to breathe, it is advised that you begin providing rescue breathing.
Breathing (Rescue Breathing)
- Pinch the persons nose shut using your thumb and forefinger. Keep the heel of your hand on the persons forehead to maintain the head tilt. Your other hand should remain under the persons chin, lifting up.
- Inhale normally (not deeply) before giving a rescue breath to a victim.
- Immediately give two full breaths while maintaining an air-tight seal with your mouth on the persons mouth. Each breath should be one second in duration and should make the victims chest rise. (If the chest does not rise after the first breath is delivered, perform the head tilt-chin lift a second time before administering the second breath.) Avoid giving too many breaths or breaths that are too large or forceful.
Circulation (Chest Compressions)
- After giving two full breaths, if the victim is not coughing, moving or gasping (obvious signs of circulation) begin chest compressions.
- Kneel at the persons side, near his or her chest.
- With the middle and forefingers of the hand nearest the legs, locate the notch where the bottom rims of the rib cage meet in the middle of the chest.
- Place the heel of the hand on the breastbone (sternum) next to the notch, which is located in the center of the chest, between the nipples. Place your other hand on top of the one that is in position. Be sure to keep your fingers up off the chest wall. You may find it easier to do this if you interlock your fingers.
- Bring your shoulders directly over the persons sternum. Press downward, keeping your arms straight. Push hard and fast. For an adult, depress the sternum about a third to a half the depth of the chest. Then, relax pressure on the sternum completely. Do not remove your hands from the persons sternum, but do allow the chest to return to its normal position between compressions. Relaxation and compression should be of equal duration. Avoid interruptions in chest compressions (to prevent stoppage of blood flow).
- Use 30 chest compressions to every two breaths (or about five cycles of 30:2 compressions and ventilations every two minutes) for all victims (excluding newborns). You must compress at the rate of about 100 times per minute.
- Continue CPR until advanced life support is available.
Using an AED in conjunction with CPR:
- AEDs are voice prompted and walk the responder through the process. The first step is to turn the device on. If possible, continue to perform CPR while a second responder turns the AED on and places the pads. You would stop CPR when the machine verbalizes not to touch the victim.
If using an AED on a one- to eight-year-old child, use a pediatric adapter or pediatric pads if available. However, do not use child pads or a child adapters with an adult in cardiac arrest because the smaller dose may not defibrillate adults properly.
CPR for Infants (Up to One Year Old)
- With infants, be careful not to tilt the head back too far. An infants neck is so pliable that forceful backward tilting might block breathing passages instead of opening them.
- Do not pinch the nose of an infant who is not breathing. Cover both the mouth and the nose with your mouth and breathe slowly (one to one and a half seconds per breath), using enough volume and pressure to make the chest rise.
- With a small child, pinch the nose closed, cover the mouth with your mouth and breathe at the same rate as for an infant. Rescue breathing should be done in conjunction with chest compressions.
Chest Compressions on Infants
- If alone with an unresponsive infant, give five cycles of CPR (compressions and ventilations) for about two minutes before calling 911 or your local emergency number.
- Use only the tips of the middle and ring fingers of one hand to compress the chest at the sternum (breastbone), just below the nipple line, as described in the table below. The other hand may be slipped under the back to provide a firm support. (However, if you can encircle your hands around the chest of the infant, using the thumbs to compress the chest, this is better than using the two-finger method.)
- Depress the sternum between a third to a half the depth of the chest at a rate of at least 100 times a minute.
- Two breaths should be given during a pause after every 30 chest compressions (a 30:2 compression-to-ventilation ratio or two breaths about every two minutes) on all infants (excluding newborns).
- Continue CPR until emergency medical help arrives.
Small Children (ages one to eight)
- Give five cycles of CPR (compressions and ventilations) for about two minutes before calling 911.
- Use the heel of one or two hands, as needed, and compress on the breastbone at about the nipple line.
- Depress the sternum about a third to a half the depth of the chest, depending on the size of the child. The rate should be 100 times per minute.
- Give two breaths for every 30 chest compressions (30:2 ratio) or two breaths about every two minutes.
- Continue CPR until emergency medical help arrives.
Choking is signaled by an inability to speak, cough or breathe, and may result in a loss of consciousness and death. Avoid using excessive force in employing an abdominal thrust to avoid injury to the ribs or internal organs. Given the potentially life-or-death nature of the situation, use your best judgment.
In the event of choking, the American Heart Association offers the following guidelines:
In the event of choking, rescuers should take action if they see signs of severe airway obstructions (including poor air exchange and increased breathing difficulty, a silent cough, cyanosis or if the person is unable to speak or breathe).
- To differentiate between mild airway obstruction and severe airway obstruction, the rescuer should ask, “Are you choking?” If the victim nods yes, assistance is needed. Choking also often is indicated by the Universal Distress Signal (hands clutching the throat).
- If the person can speak, cough or breathe, do not interfere.
- If the person cannot speak, cough or breathe, give abdominal thrusts.
- To employ abdominal thrusts, reach around the person’s waist. Position one clenched fist above the navel and below the rib cage. Grasp your fist with your other hand. Pull the clenched fist sharply and directly backward and upward under the rib cage 5 times quickly, repeat as needed.
- In case of obesity or late pregnancy, give chest thrusts.
- Continue uninterrupted until the obstruction is relieved or advanced life support is available. In either case, the person should be examined by a physician as soon as possible.
Position the person on his or her back, arms by side.
- Shout for help. Call 911 or the local emergency number.
- Look inside the victims mouth to see if you can locate the obstruction. If you can see the object and believe that you can remove it you can perform a finger sweep. Only remove an object you can see and easily extricate.
- Attempt two rescue breaths reopening the airway by tilting the head if you do not see chest rise and fall with your breaths.
- Place the heel of your clasped hands on the center of the chest on the nipple line and perform 30 compressions, approximately 2 inches deep.
- Repeat sequence: look in the mouth to see if you can locate the object, attempt rescue breathing, perform compressions, until successful.
- Continue uninterrupted until the obstruction is removed or advanced life support is available. When successful, have the person examined by a physician as soon as possible.
- After the obstruction is removed, continue CPR, if necessary.
Conscious Infant (Under one year old)
- Support head and neck with one hand. Place the infant face down over your forearm, head lower than torso, supported on your thigh.
- Deliver up to five back blows, forcefully, between the infant’s shoulder blades using the heel of your hand.
- While supporting the head, turn the infant face up, head lower than torso.
- Using two or three fingers, deliver up to five thrusts in the sternal (breastbone) region. Depress the sternum to 1 inch for each thrust. Avoid the tip of the sternum.
- Repeat both back blows and chest thrusts until the foreign body is expelled or the infant becomes unconscious.
- Do not perform blind finger sweeps or abdominal thrusts on infants.
Unconscious Infant (Under one year old)
Shout for help. Call 911 or the local emergency number.
- Perform the tongue-jaw lift. (Grip on the jaw by placing your thumb in the infant’s mouth and grasping the lower incisor teeth or gums; the jaw then lifts upward.) If you see the foreign body and you believe you can remove it attempt to do so.
- Attempt two rescue breaths reopening the airway by tilting the head if you do not see chest rise and fall with your breaths.
- Using two or three fingers, deliver up 30 compressions in the sternal (breastbone) region. Depress the sternum to 1 inch for each thrust. Avoid the tip of the sternum.
- Repeat the sequence.
- If the foreign body is removed and the infant is not breathing, continue CPR.
Conscious Child (Over one year old)
To dislodge an object from the airway of a child:
- Perform abdominal thrusts as described for adults. Avoid being overly forceful in order to avert injury to ribs and internal organs.
Unconscious Child (Over one year old)
If the child becomes unconscious, continue as for an adult.
If you are choking and are alone:
Do not panic; if possible, take slow breaths.
- Call 911 or the local emergency number immediately (even if you cannot speak); the dispatcher should be able to recognize that an emergency is occurring. If you are using a land-line, in some (but not all) areas, he or she may then be able to trace the call and send emergency personnel to you. (Cell phone calls may not be traceable to an exact location.)
- If you are able go to the front door, unlock and open the door so first responders will be able to locate you and see the issue.
- If available, lean over the back of a chair and press hard on your abdomen and chest to expel the object or attempt to use your fists to give yourself abdominal thrusts.
- Continue uninterrupted until the obstruction is expelled or advanced life support is available. In either case, you should be examined by a physician as soon as possible.
Most cuts can be treated by cleaning with soap and water and applying a clean bandage. You also may want to treat the cut with an antibiotic ointment. If you delay care for only a few hours, even a minor wound can build enough bacteria to cause a serious infection and increase the risk of a noticeable scar.
Puncture wounds may not seem very serious, but because germs and debris are carried deep into the tissues, a physician evaluation may be needed. In addition, antibiotics or a tetanus shot may be required. Do not remove the object that caused the puncture if it is still impaled in the wound. Think of a water balloon with a nail in it. What is going to occur if you remove the nail?
Seek medical attention for a cut or a wound that shows any of the following signs:
Long or deep cuts that need stitches
Cuts over a joint
Cuts from an animal or human bite
Cuts that may impair function of a body area, such as an eyelid or lip
Cuts that remove all the layers of the skin, like slicing off the tip of a finger
Cuts caused by metal objects or puncture wound
Cuts over a possible broken bone
Cuts that are deep, jagged or “gaping” open
Cuts that have damaged underling nerves, tendons or joints
Cuts that have foreign materials, such as dirt, glass, metal or chemicals embedded in them
Cuts that show signs of infection, such as fever, swelling, redness, a pungent smell, pus or fluid draining from the area
Cuts that include problems with movement or sensation, or increased pain
Seek emergency care if:
The wound is still bleeding after a few minutes of steady, firm pressure with a cloth or bandage
Signs of shock occur
Breathing is difficult because of a cut to the neck or chest
There is a cut to the eyeball
There is a cut that amputates or partially amputates an extremity
There is a deep cut to the abdomen that causes moderate to severe pain
Diabetics may experience life-threatening emergencies from too much or too little insulin in their bodies. Too much insulin can cause a low sugar level (hypoglycemia), which can lead to insulin shock. Not enough insulin can cause a high level of sugar (hyperglycemia), which can cause a diabetic coma.
Symptoms of insulin shock include:
Pale, sweaty skin
Numbness in hands or feet
Symptoms of diabetic coma include:
- Weak and rapid pulse
- Deep, sighing breaths
- Unsteady gait
- Flushed, warm, dry skin
- Odor of nail polish or sweet apple
- Drowsiness, gradual loss of consciousness
First aid for both conditions is the same:
- If the person is unconscious or unresponsive, call 911 or your local emergency number immediately.
If an unconscious person exhibits life-threatening conditions, place the person horizontally on a flat surface, check breathing, pulse and circulation, and administer CPR, if needed, while waiting for professional medical assistance
If the person is conscious, alert and can assess the situation, assist him or her with getting sugar or necessary prescription medication.
If the person appears confused or disoriented, give him or her something to eat or drink and seek immediate medical assistance.
Drowning occurs most often among small children and people who can’t swim, but even experienced swimmers may be susceptible, depending on weather conditions, water currents, their health and other circumstances.
In the United States, it is the second leading cause of death, after motor vehicle crashes, in children 12 and younger. Children have drowned in wading pools and even bath tubs. It only takes a few seconds for a child to drown.
If a person appears to be drowning (e.g., is flailing in the water, yelling for help, coughing or going under, or appears to be unconscious or floating in the water), call or have someone call 911 or your local emergency number. In addition:
Do not attempt to rescue a drowning person while in the water yourself unless you are trained to do so and have lifesaving equipment. People who are drowning may panic and pull you underwater with them; dangerous circumstances – such as strong currents or rip tides – may also endanger you.
If possible, reach out with or throw an object that floats to the person from a secure out-of-water position, such as a boat, a swimming pool ladder or a dock.
For a person pulled from the water, tilt the head back, lift the chin and check for breathing and other signs of life. Expel fluid or other objects from the mouth.
o If the person is not breathing, give two slow rescue breaths. If you see chest rise and fall with your breaths, begin CPR. If rescue breaths do not go in, reposition the airway and reattempt.
o If the person is still not breathing after rescue breaths are administered, see Unconscious Choking.
Causes of electrical injury and shock include accidental exposure to household or appliance wiring, arcs from power lines, the severing of an electrical cord or sticking of foreign objects into an outlet, typically in the case of a young child, faulty machinery and occupational accidents.
Symptoms of electrical injury or resulting shock may include:
- Numbness, tingling
- Muscle contraction or pain
- Bone fractures
- Hearing impairment
- Irregular heart rhythms
- Cardiac arrest
- Respiratory failure
Whether a person survives an electric shock depends on the type of circuit (AC or DC current), level of the voltage, level of amperage, the way in which the current entered the body, the duration of exposure, the victim’s general health, and the timing and adequacy of treatment. Seeking immediate emergency assistance is vital in such situations.
To assist someone with an electrical injury:
Check to see if the person is still in contact with the electric current. If so, don’t touch the person, and find another way to shut off the power, such as at the circuit or breaker box. A victim in contact with an AC current (household current) may not be able to let go of the point of contact because their muscles contract strongly in response to the electricity.
Check breathing and pulse.
- Call 911 or emergency number.
A head injury is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.
If a person loses consciousness after a head injury, then the person has had a “concussion,” which may be serious because it means there has been a temporary loss in brain function. Some people with concussions do not lose consciousness, and brain injuries can occur without a loss of consciousness.
Danger Signs – Adults
Severe head injuries can involve bruising, fracture, swelling, internal bleeding or a blood clot. Seek emergency care if you notice any of these signs of severe head injury:
Headaches that worsen, despite over-the-counter pain medications.
Weakness, numbness or decreased coordination.
Loss of consciousness for more than one minute.
Person is unconscious or cannot be awakened.
Unequal pupil sizes – one pupil (the black part in the middle of the eye) is larger than the other.
Convulsions or seizures.
Increased confusion or agitation.
You do not need to prevent a person with a head injury from sleeping as a safeguard against going into a coma; this concept is a myth. If the person has neck pain, try to prevent any movement of the neck.
Danger Signs – Children
Seek emergency medical assistance if the child:
Exhibits any of the danger signs listed for adults.
Won’t stop crying.
Can’t be consoled.
Refuses to eat or nurse.
In infants, exhibits bulging in the soft spot on the front of the head.
Shows any sign of skull trauma or obvious abnormality of the skull, such as bruising on the scalp or a depressed area at the location of the injury.
Heart attack, or myocardial infarction, remains the leading killer of both men and women in the United States. More than 400,000 Americans die from heart attacks each year. Getting emergency medical help immediately can dramatically increase the chances of survival and recovery.
A heart attack is not always a sudden, deadly event. Often it is an evolving process during which a clot forms in an artery of the heart, depriving the heart of blood and oxygen. The longer the heart attack process continues, the more permanent damage is done to otherwise healthy heart muscle.
Many people ignore the warning signs of a heart attack or wait until their symptoms become unbearable before seeking medical help. Others wait until they are absolutely sure it’s a heart attack because they worry they will look foolish if it is a false alarm. These reactions can result in dangerous delays.
People often will experience some, but not all, of the following symptoms, which may come and go:
- Uncomfortable pressure, fullness, squeezing sensation or pain in the center of the chest, lasting more than a few minutes, or it goes away and comes back.
- Pain that spreads to the shoulders, neck, jaw, arms or back.
Chest discomfort accompanied by lightheadedness, fainting, sweating, nausea or shortness of breath.
Some less common warning signs of heart attack that should be taken seriously, especially if they accompany any of the above symptoms, include:
Shortness of breath and difficulty breathing.
- Abnormal chest pain (angina), stomach, or abdominal pain. (Symptoms may feel like indigestion or heartburn.)
- Nausea or dizziness.
- Unexplained anxiety, weakness, or fatigue.
- Palpitations, cold sweat or paleness.
As with men, women’s most common heart attack symptom is chest pain or discomfort. Women are more likely than men to experience shortness of breath, nausea/vomiting and back or jaw pain.
If you suspect someone is having a heart attack:
- Call 911 or your emergency services number immediately. Stay with the person until the ambulance arrives. Do not attempt to drive the person to the hospital; if his or her condition should worsen, there is nothing you can do to help while driving.
- After 911 is called, the EMS dispatcher will likely give pre-arrival instructions (when appropriate) for the administration of aspirin (not acetaminophen, ibuprofen or naproxen) and nitroglycerin (if prescribed) while emergency-response units are enroute to the scene The ideal aspirin dose in such instances is two to four baby aspirin or one full or extra strength tablet (325 or 500mg), and chewing helps get the aspirin into the bloodstream faster than swallowing it whole. (The patient should not be given aspirin if his or her physician has advised otherwise, e.g., because of allergies or possible harmful interactions with other medications or known disease complications).
- If the person is conscious, keep the person calm and help him or her into a comfortable position. The victim should stop all physical activity, lie down, loosen clothing around the chest area, and remain calm until the ambulance arrives.
- If the person becomes unconscious, make sure the they are lying on his or her back. Clear the airway and loosen clothing at the neck, chest and waist. check for breathing and pulse; if the victims not breathing begin rescue breathing, it they do not have a discernable pulse or they are not coughing, gasping or moving begin cardiopulmonary resuscitation (CPR).
Heat-related illness can be caused by overexposure to the sun or any situation that involves extreme heat. Young children and the elderly are most at risk, but anyone can be affected.
Symptoms include muscle spasms, usually in the legs and stomach area.
- To treat, have the person rest in a cool place and give small amounts of cool water, juice or a commercial sports liquid. (Do not give liquids if the person is unconscious.)
- Gently stretch and massage the affected area.
- Do not administer salt tablets.
- Check for signs of heat stroke or exhaustion.
Heat Stroke and Exhaustion
Symptoms of early heat exhaustion symptoms include cool, moist, pale or flushed skin; headache; dizziness; weakness; feeling exhausted; heavy sweating; nausea; and giddiness.
Symptoms of heat stroke (late stage of heat illness) include flushed, hot, dry skin; fainting; a rapid, weak pulse; rapid, shallow breathing; vomiting; and increased body temperature of more than 104 degrees.
- People with these symptoms should immediately rest in a cool, shaded place and (if conscious) drink plenty of non-alcoholic, non-caffeinated fluids.
- Apply cool, wet cloths or water mist while fanning the person.
- Seek immediate medical attention by calling 911 or your local emergency number for symptoms that include cool, moist, pale skin, rapid pulse, elevated or lowered blood pressure, nausea, loss of consciousness, vomiting or a high body temperature.
- For late stage heat stroke symptoms, cool the person further by positioning ice or cold packs on wrists, ankles, groin and neck and in armpits.
- Administer CPR if the person becomes unconscious.
Trauma to the neck and back can lead to spinal cord injury and permanent disability. When someone has a head or neck injury, he or she should not be moved because movement may cause further damage to spinal cord nerves, which carry messages between the brain and body, resulting in possible paralysis below the site of the injury.
The symptoms of serious neck or back injury include:
Head or body contorted in an unnatural or unusual position
Numbness or tingling sensations that radiate through an arm or a leg
Weakness in back, neck or limbs
Difficulty standing or walking
Inability to move arms or legs
Loss of bladder or bowel control
Shock (pale, clammy skin; blue or gray lips, fingernails; dazed or semi-conscious appearance)
Neck pain, stiff neck or headache that won’t go away
If any of the above causes or symptoms are involved, assume that the person has a spinal cord injury, and take the follow steps:
Call 911 or the local emergency number.
Immobilize the head, neck and shoulder area to prevent movement.
Do not attempt to reposition, bend or twist the neck or body; and do not move or roll the person unless he or she is in danger (e.g., he or she is in a burning vehicle).
o If you must roll the person, do so only if he or she is vomiting or choking on blood, or because you must check that the person is still breathing.
o Rolling a person requires two people, with one person stationed at the head and the other along the victim’s side. The person’s head, neck and back should be kept in line while rolling occurs.
If the person is wearing a helmet, do not remove it.
If the person is not breathing, begin rescue breathing and CPR, if necessary. Do not move or tilt the head back when attempting to open the airway; instead, position your fingers on each jaw along the side of the head and lift the jaw open or forward.
A stroke is an interruption of the blood supply to any part of the brain by a clogged or burst artery. The interruption deprives the brain of blood and oxygen and causes brain cells to die. Seek emergency care immediately if a stroke is suspected.
Stroke symptoms in general include:
Sudden numbness, weakness or paralysis and drooping of the face, arm or leg, especially on one side of the body.
Suddenly blurred or decreased vision in one or both eyes.
Slurred speech, difficulty speaking or inability to understand or be understood.
Loss of balance or coordination.
Headache, frequently abrupt onset.
Stroke symptoms that last for only a few minutes and then subside may indicate a “mini-stroke,” or a transient ischemic attack (TIA). TIAs are serious medical events and require treatment; they are also a warning sign that a more dangerous stroke may occur in the future.
It is important to know that stroke often goes unrecognized; people often wait to see if their symptoms improve and unknowingly put themselves in greater danger. However, because stroke can incapacitate or kill within minutes, doctors recommend treating a suspected stroke as a medical emergency and seeking immediate medical care. To help someone with the symptoms of a stroke call 911 and have the victim lie down and stay with them.
If you answer “yes” to any of the following questions about a person experiencing a medical emergency, or if you are unsure, it’s best to call an ambulance, even if you think you can get to the hospital faster by driving yourself.
Does the person’s condition appear life-threatening?
- Could the person’s condition worsen and become life-threatening on the way to the hospital?
- Could moving the person cause further injury?
- Does the person need the skills or equipment employed by paramedics or emergency medical technicians?
- Would distance or traffic conditions cause a delay in getting the person to the hospital?
If you drive to the hospital, know the location and the fastest route to the nearest emergency department. In addition:
Don’t delay care by driving to a more distant hospital emergency department.
- If necessary, a patient may be transferred to a hospital with special capabilities, such as a regional trauma or pediatric center.
If you call an ambulance, keep in mind that even though the 911 system was introduced in 1968, the network still does not completely cover some rural areas of the United States and Canada. When traveling, check for local EMS numbers in the areas where you will be, so you have this information before you begin your journey.
Also, be aware it is important for people calling 911 from wireless phones to tell the emergency operator the location of the emergency, because a cell tower provides only very general information about the location of a caller. Some cars now are equipped with “smart” technologies that use global positioning system satellites and cellular technology to link vehicles to direct emergency help, but many are not.
When you call for help, remember to:
- Speak calmly and clearly.
- Give the name, address, phone number, and location of the person in need and describe the nature of the problem.
- Don’t hang up until the dispatcher tells you to. The dispatcher may need more information.
- Teach children how to place an emergency call.
Managing Intense Emotions
When people are first faced with disaster intense emotions are often present and appropriate. They are a result of intense fear, uncertainty, and apprehension.
Establish a Relationship:
Use Concrete Questions to Help the Person
It is also an important note to remember your emotional needs, as well. In the flurry of an emergency things happen very quickly. Many times the ambulance arrives and they whisk away the victim and you are left with the aftermath of never even knowing what happened next. It is important to talk to someone about what occurred and how you feel.
In Case of Emergency (ICE)
A cell phone can become a source of information for paramedics and other emergency personnel responding to accidents, crimes and disasters when individuals add ICE (In case of emergency) to the contact list or address book on the phone. Medical professionals use this information to notify the person’s emergency contacts and to obtain critical medical information if a patient arrives unconscious or unable to answer questions.
Knowing what constitutes an emergency, where to get help and what to do while you’re waiting for help can save a life. You are never expected to do more than you are trained to do. Do your part by staying up to date on how to respond.