NATIONAL CERTIFICATE: BUILDING AND CIVIL

CONSTRUCTION
ID 65409 LEVEL 3 – CREDITS 140
SAQA:- 254220
LEARNER GUIDE
PROVIDE PRIMARY EMERGENCY CARE/FIRST AID AS
AN ADVANCED FIRST RESPONDER

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Learner Information:
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Name & Surname:
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Facilitator Name:
Date Started:
Date of Completion:

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5|Page
Learner Guide Introduction
About the Learner This Learner Guide provides a comprehensive overview of the Provide
Guide… primary emergency care/first aid as an advanced first responder and
forms part of a series of Learner Guides that have been developed for National
Certificate: Building and Civil Construction ID 65409 LEVELS 3 – 140
CREDITS. The series of Learner Guides are conceptualized in modular’s
format and developed for National Certificate: Building and Civil
Construction. They are designed to improve the skills and knowledge of
learners, and thus enabling them to effectively and efficiently complete
specific tasks.

Learners are required to attend training workshops as a group or as specified

by their organization. These workshops are presented in modules, and
conducted by a qualified facilitator.

Purpose A learner achieving this unit standard will be able to apply sound food safety
principles by identifying risk factors in food contamination and applying
preventative measures to ensure product safety.
Learners will gain an understanding of sustainable agricultural practices as
applied in the animal-, plant and mixed farming sub fields. This unit standard
focuses on the application of food safety principles in primary agriculture.
They will be able to participate in, undertake and plan farming practices with
knowledge of their environment. This unit standard will instill a culture of
maintenance and care for both the environment as well as towards farming
infrastructure and operations.

Outcomes At the end of this module, you will be able to:

 Explain the principles of advanced primary emergency care in all health
emergencies.
 Demonstrate an advanced level of preparedness to deal with potential
emergencies.
 Assess and manage a complex emergency scene/disaster.
 Explain the applied anatomy and physiology of the human body systems
and describe the emergency care management of disorders and diseases
relating to each physical system.

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Assessment Criteria The only way to establish whether a learner is competent and has
accomplished the specific outcomes is through an assessment process.
Assessment involves collecting and interpreting evidence about the learner’s
ability to perform a task.
This guide may include assessments in the form of activities, assignments,
tasks or projects, as well as workplace practical tasks. Learners are required to
perform tasks on the job to collect enough and appropriate evidence for their
portfolio of evidence, proof signed by their supervisor that the tasks were
performed successfully.
To qualify To qualify and receive credits towards the learning programme, a registered
assessor will conduct an evaluation and assessment of the learner’s portfolio of
evidence and competency
Range of Learning This describes the situation and circumstance in which competence must be
demonstrated and the parameters in which learners operate
Responsibility The responsibility of learning rest with the learner, so:
 Be proactive and ask questions,
 Seek assistance and help from your facilitators, if required.

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 Provide primary emergency care/first aid

1
as an advanced first responder

Learning Unit

UNIT STANDARD NUMBER : 254220

LEVEL ON THE NQF : 3
CREDITS : 8
FIELD : Health Sciences and Social Services
SUB FIELD : Preventive Health

This unit standard is intended to enable the first responder in an emergency situation to react
to health emergencies at an advanced level, until the arrival of more qualified emergency
personnel.
PURPOSE:
Qualifying learners will be capable of:

 Explaining the principles of advanced primary emergency care in all health emergencies.
 Demonstrating an advanced level of preparedness to deal with potential emergencies.
 Assessing and managing a complex emergency scene/disaster.
 Explaining the applied anatomy and physiology of the human body systems and describing
the emergency care management of disorders and diseases relating to each physical system.
 Applying primary emergency life support for all age groups according to international
and/or national protocols.
 Explaining and managing shock.

NB: The certificate of competency associated with this unit standard will only be valid for
three years only to ensure relevancy with rapidly changing internationally researched
emergency care protocols.
LEARNING ASSUMED TO BE IN PLACE:

 Communication at NQF Level 2.

 Mathematical literacy at NQF Level 2.
 SAQA ID 120496: Provide risk-based primary emergency care/first aid in the workplace.
 SAQA ID 244574: Apply knowledge of HIV/AIDS to a specific business sector and a workplace.

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 SESSION 1.
Explain the principles of advanced primary emergency care in all
health emergencies.

Learning Outcomes
 The aims of emergency care are identified and explained with relevance to the risks of a specific
situation.
 Universal precautions used during treatment of sick and injured are identified and their purposes
explained and applied in terms of accepted health procedures.
 The specific medico-legal implications of risk based primary emergency care are identified and
explained in terms of current relevant legislation and regulations.

The aims of emergency care

WHAT IS EMERGENCY CARE?
 Simple, effective management or care given to a casualty.
 Can be through injury or sudden illness.
 Priority until more advanced care is provided.
AIMS OF EMERGENCY CARE
 Preserve Life.
 Protect unconscious casualty.
 Prevent the condition worsening and relieve pain.
 Promote recovery.

1. Emergency telephone calls

Aim
1. Dial the correct telephone number.
2. Give your name and number to the emergency dispatcher.
3. State exactly what happened in clear terms.
4. Be able to give an adequate description of the address or location of the medical emergency.
5. Do not replace the receiver until after enquiring of the dispatcher as to what can be done for the casualty
while waiting for the Emergency Medical Services (EMS)
Emergency Medical Services Telephone Number in South Africa - 10177
In Case Of Difficulty with an Emergency Call- Dial 1022

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REMEMBER – Always have the correct cash available for a public telephone.

The chain of survival

When breathing or the heart stops, the process of survival becomes a chain. This chain is made up of the
various steps or links that make all the difference to the ultimate survival of the casualty of a cardiac arrest. The
quicker effective professional treatment is started, the greater the chances of the casualty surviving. It is
important to understand that each little delay can add up to a fatal delay and so it is vitally necessary to ensure –
EARLY AWARENESS

EARLY ACCESS BY THE EMERGENCY MEDICAL SERVICES (EMS) – time is critical – they must be
activated as soon as possible.

Begin with

EARLY CARDIO PULMONARY RESUSCITATION (CPR) and

EARLY PROFESSIONAL ADVANCED LIFE SUPPORT

Aim
To ensure timely arrival of the emergency Medical Services to ensure early Advanced Life Support thus
ensuring a better chance of survival for the casualty.
Action to take
1. Early awareness – know the early warning signs of cardiac arrest.
2. First alert the Emergency Medical Services – telephone 10177 to ensure early access.
3. If an arrest is WITNESSED, administer a Single precordial thump within one minute
4. Begin CPR immediately

Action at an emergency

The basic principles of First Aid apply to all injuries or illnesses regardless of severity. Whatever the incident,
it is the First Aider’s responsibility to act quickly, calmly and correctly in order to preserve life, prevent
deterioration in the casualty’s condition and promote recovery. These objectives are best achieved by:
 A rapid but calm approach.

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 A quick assessment of the situation and the casualty.
 A correct diagnosis of the condition based on the history of the incident, symptoms and signs.
 Immediate and appropriate treatment of any conditions.
 Proper disposal of the casualty according to the injury or condition.

Approach
This should be speedy but calm and controlled. Ensure that you are not placing yourself in any danger when
approaching the casualty. On arriving at the scene of any accident, state that you are a trained First Aider and, if
there are no doctors, nurses or more experienced people present, calmly take charge.

Assessing the situation

As soon as you have taken control, it is crucial that you make an accurate assessment of the situation and
decide on the priorities of action. The conditions which affect these are as follows: Safety, Getting Others to
Help, Determining the Priorities of Treatment and calling for Assistance.
Safety
Minimize the risk of danger to yourself, the casualty and any bystanders, and guard against any further
casualties arising. In the case of:
 Road Accidents Instruct a bystander to control the traffic, keeping it well away from yourself and the
casualty. Watch out for fire risks, especially from petrol spillage and switch off the ignition of the vehicles
concerned.
 Gas and poisonous fumes If possible cut off the source.
 Electrical contact Break the contact, if possible, and take the necessary precautions against further contact.
 Fire and collapsing buildings Move the casualty to safety immediately.
 Blood and body fluids Take precautions, e.g. wear rubber or plastic gloves to minimize contact with such
fluids.
Getting others to help you

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Some bystanders can be extremely useful and may be able to assist with treatment, for example, controlling
severe bleeding or supporting a badly injured limb. Other bystanders may become nuisances so you must keep
them occupied to prevent them interfering with you work. They can be asked to control traffic or crowds, or be
sent to telephone for assistance. However, when sending bystanders to telephone make sure they understand the
message that is to be sent, if possible, ask them to write it down but, in any case, ask them to repeat the
message to you before actually sending it. Always make sure that they report back to you afterwards.
Universal precautions used during treatment of sick and injured are identified and their purposes
explained and applied in terms of accepted health procedures.
Universal precautions
The term universal precautions (UP) refers to the standards of infection control developed to prevent
exposure and transmission of blood-borne infectious agents like HIV and hepatitis virus. In some texts you will
find them referred to as ‘standard procedures’, because they should be routine in all contacts with patients. The
universal precautions that are described here should be implemented and practised at all times by all healthcare
providers and caregivers in all settings, in particular in hospitals, health centres, health posts and community
settings, as well as in the homes of your patients.
Standard Precautions (or Universal Precautions) are work practices that are required for the basic level of
Infection Control. They include:
 Good hygiene practices
 Frequent hand washing
 The appropriate use of gloves
 The use of other personal protective equipment, such as eye protection, masks, aprons, gowns and overalls
 The safe use and disposal of sharp instruments, such as needle and syringes
 The use of disposable equipment where applicable and available
 Correct cleaning, disinfection and sterilization of non-disposable equipment
 Safe collection, storage and disposal of waste
 The appropriate use of cleaning agents
 Protocols for preventing and managing occupational exposures to blood or body substances
Why do we need Standard Precautions?
Standard Precautions will help stop the spread of infections. Often you can’t tell who is infected with a disease,
or the person may be infected but have not yet developed any signs or symptoms. Some diseases can take
several months before people become sick but they can still be infectious.
Therefore ALL body substances (except sweat and tears) of ALL people are considered to be potential sources
of infection.
DETERMINING THE PRIORITIES OF TREATMENT

In order to determine the condition of a casualty, perform the following checks immediately.
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AIRWAY AND BREATHING
Quickly check that the airway is open and that the casualty is breathing. If not, commence Artificial Ventilation
immediately
BLEEDING

Check the casualty for any severe bleeding and control it.
UNCONSCIOUSNESS
Place an unconscious casualty, or one who’s breathing is noisy, in the Recovery Position and establish the level
of responsiveness. If there is a possibility of spinal injury do not remove the casualty, unless difficulty in
breathing makes it essential.
SHOCK
Keep the casualty warm, quiet and lying down until skilled help arrives.

OTHER NEEDS
Unless there is immediate danger to life from the surroundings treat all fractures and large wounds before
moving the casualty. If the casualty is in danger, temporarily immobilize the injured part before moving.

CALLING FOR ASSISTANCE

Once you decide that assistance is required, and this may include ambulance, police, fire brigade, gas or
electricity boards, send for it immediately. You will find police, ambulance and other emergency telephone
numbers at the front of your local telephone directory.
Whether you are giving the message yourself or instructing someone to do so make sure that the following
information is passed on:
 Your telephone number (if for any reason you are cut off the officer will then be able to contact you).
 The exact location of the incident; if you can, point out nearby road junctions or other landmarks.
 An indication of the type of seriousness of the incident, for example, Road traffic accident, two cars
involved, three people trapped”.
 The number, sex and appropriate age of the casualties involved and, if possible, the nature of their injuries.
Request special aid if you suspect a heart attack or childbirth.
NB Each control officer has direct access to the other emergency switchboards and will pass on any message, if
necessary.
Do Not replace the receiver before the control officer does so.

MULTIPLE CASUALTIES AND INJURIES

Where there is more than one casualty, you must decide by rapid assessment which one should receive priority
of treatment. You should open the airway of any casualty whose breathing has stopped or is failing and, if

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necessary, start Artificial Ventilation. Any unconscious casualty should be placed in Recovery Position
immediately, especially if you are working alone. Temporary control of continuous severe bleeding should be
affected with the assistance of the casualty or a bystander. Remember that the noisiest casualty is rarely the
most severely injured. It should also be remembered that in First Aid common sense is almost as important as
the actual knowledge of the subject. In real life it will be found that serious accidents rarely produce only a
single injury. Frequently two or more injuries occur so that the correct treatment of one may interfere with the
other. In such circumstances, you must decide which injury is more serious and treat that one in the correct
way. You should then deal with the second injury as correctly as possible under the conflicting circumstances.

DIAGNOSIS

Having dealt with the priorities, you should then attempt a fuller diagnosis. This takes account of the casualty’s
history (and that of the incident), the symptoms, signs and level of responsiveness.

HISTORY

This is the full story of how the incident occurred or the illness began, and should be taken directly from the
casualty and a responsible bystander wherever possible. For example, a casualty may only say “ I slipped and
fell down” whereas a witness may say, “I saw the old man fall and his head hit the wall”. Pay full attention to
the story which may provide clues to the likely injuries and especially if you suspect an existing illness such as
diabetes or heart disease. Make a note of details of past similar occurrences and treatments for the examining
doctor’s benefit later. Never hurry the casualty and remember to pass on all the information when skilled help
arrives.

SYMPTOMS

These are sensation that the casualty feels and describes to you – the most useful of these is pain. If the casualty
is conscious, ask if there is any pain and if so, where. Examine the part first, and then run through the various
sites at which pain is felt. Remember, however, that a severe pain in one area may mask a more serious injury,
which produces less pain, in another. Other useful symptoms the casualty may disclose are nausea, giddiness,
feelings of heat and cold, or loss of muscular control or sensation. All symptoms should then be investigated
and confirmed by a physical examination for signs of abnormality, such as injury or illness. If the casualty is
unconscious, or unreliable because dazed or in shock, then diagnosis cannot be based on symptoms but has to
be based on information from bystanders and signs.
SIGNS
These are details ascertained by you using your senses – sight, touch, hearing and smell. These may be: signs of
injury such as bleeding, swelling, deformity or signs of illnesses such as a raised temperature and/or a rapid or
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an irregular pulse. All these signs may be immediately obvious, noticed incidentally or deliberately discovered
by examination.
EXAMINATION
A general examination should be carried out quickly to discern any imminent threats to life weather the
casualty are conscious or unconscious. Move the casualty as little as possible: begin your examination at the
casualty’s head and work methodically towards the feet. Remember to look, feel, listen and smell and always
compare one side of the body with the other. If at any stage during the examination the casualty’s breathing
becomes difficult, place the casualty in the Recovery Position.
HEAD
Mouth Re-check breathing, notice the rate, depth, the nature (whether easy or difficult, noisy or quiet); note
also an odour. Check the inside of the mouth quickly to ensure there is no foreign matter in it, such as vomit,
blood, food, loose teeth, that might cause choking. Examine the lips for any signs of burning or discoloration
that might indicate corrosive poisoning. Look inside the lips for any trace of blueness, which might indicate
asphyxia. Check the teeth to make sure that any recently dislodged teeth have not fallen down into the back of
the throat. Make sure that the dentures are firm fitting (essential for resuscitation); if they are not they should be
removed.

Nose Check for signs of blood, clear fluid or a mixture of both which might come from the inside of the skull.
Eyes Examine both together noting the resistance of the eyelashes to touch. Compare the pupils (the black
circular centres) and note whether they are equal in size. The white orb of the eye should be examined for
bloodshot appearance.

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Face Look at the colour; it may be pale or flushed, or even bluish if breathing is affected. At the same time, feel
the temperature of the face to check whether it is particularly hot or cold and note the state of the skin –
whether it is dry or clammy or even sweating profusely.

Ears These should be checked for foreign bodies and traces of blood and or clear
Cerebro-spinal fluid that might indicate skull fracture. Speak into the casualty’s ear to test hearing.
Skull Gently run the hands over the scalp searching for bleeding, swelling or indication that might indicate a
fracture.

NECK
Loosen clothing around the neck. Run the fingers over the spine from the base of the skull to as far as you can
reach the shoulders, checking for any irregularity of the vertebrae that might indicate a fracture. Check round
the neck, to see whether any warning medallion is being worn. Check the carotid pulse, and note its rate,
strength, and rhythm. If the casualty is unconscious and the neck is not damaged, place the head in the Open
Air Position

SPINE
Pass your hand gently under the hollow of the back and, without moving the casualty or removing any clothing,
feel along the spine as high and as low as you can looking for
irregularity of the vertebrae or swelling.

TRUNK

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Check the chest for evenness of rib movement on breathing and examine for any wounds that might be
“sucking” air. Check the ribs for irregularity or depression that might indicate a fracture and also feel along the
line of the breastbone. Check both collar-bones for irregularity and the shoulders for deformity. Carefully feel
either side of the pelvis looking for signs of fracture and note any indication of incontinence.

ARMS
The upper-arm bones, then the bones in the fore-arm, wrists, hands and fingers should be thoroughly examined.
Check carefully for any deformity and swelling which might indicate a fracture. The fore-arms should be
checked to see if a casualty is wearing a
Medical warning bracelet and for injection marks.

LEGS
Check the hips, thighs, knee-caps, and both bones of the lower legs, the ankles, feet,
and the toes in the same way as the arms.
NB Use two hands so that both sides of the body can be examined and compared at
the same time.

LEVEL OF RESPONSIVENESS
There are various stages through which a casualty may pass during progression from consciousness to
unconsciousness. These are dealt with in detail on p.98 but, basically if the casualty responds well to stimuli
then unconsciousness is only light (as in a faint, for
example). But if the level of responsiveness is low then the casualty is more deeply

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unconscious. If the response is totally absent then the casualty is in a potentially dangerous state. Every 10
minutes you should re-check and note the casualty’s response to the stimuli of noise (speak loudly into ear),
touch (try to arouse by shaking the shoulders gently), pain (watch the face while you pinch the skin on hand or
ankle) and reflex action of the eyelids (touch the eyelashes). In addition, a similar check should be kept on the
casualty’s breathing, pulse and temperature, and the findings should be recorded.
AIDS TO DIAGNOSIS
Your diagnosis is based on information from various sources. By taking the history of the
incident, asking the casualty for symptoms and examining the casualty for signs, it should be possible to make
an accurate diagnosis. The following chart is a summary of how to achieve this.
HISTORY obtained from surroundings, casualty and bystanders

SYMPTOMS SIGNS
These are the sensation experienced by the Noted by the First Aider’s sense
casualty obtained by asking tactful questions. ___________________________________________
   
Pain
Sight Touch Smell Hearing
Tenderness
Respiration Dampness Breath Breathing
Loss of normal movement
Bleeding (bleeding, Burning Groans
Loss of sensation
(type and ncontin- Gas
Cold
volume) ence) Alcohol
Heat
Wounds Temperature
Thirst
Foreign Pulse
Nausea
bodies Swelling
Weakness
Colour of Deformity
Dizziness
face Irregularity
Faintness
Swelling Tenderness
Temporary loss of consciousness
Deformity
Loss of memory
Bruising
Reflexes
Responses
to touch
and sound
Incontinence
Vomit
Containers

EXTERNAL CLUES

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If a casualty is unconscious, the pockets, handbag or briefcase, may have to be checked for possible clues.
These may be appointment cards for hospital/clinic cards that might show that the casualty is on casualty is on
steroids or insulin or is liable to epileptic fits. Any lumps of sugar or glucose present might indicate that the
casualty is a diabetic. If possible, check this in the presence of a witness. There are a number of medical
warning items, which can be worn by persons with a medical condition. They may take the form of an inscribed
medallion or bracelet (“Medic-alert”, for example), a locket for wrist or neck or a capsule on a neck chain or
key-ring containing a strip of paper describing the condition.

TREATMENT
You should carry out the appropriate treatment for each condition found, gently and quickly. It is most
important that you reassure and encourage the casualty constantly. Work calmly and efficiently, pay attention
to any remarks or requests that the casualty makes and do not pester with questions. This is annoying for the
casualty and is a sign of nervousness on your part. After giving the necessary treatment, place the casualty in
the appropriate position and keep a watchful eye until help arrives. Bear in mind your aim is to preserve life,
prevent the condition worsening and promote recovery.

TO PRESERVE LIFE:

 Maintain an open airway by positioning the casualty correctly.

 Begin resuscitation if the casualty is not breathing and the heart in not beating and continue treatment until
skilled medical aid is available.
 Control bleeding

TO PREVENT THE CONDITION WORSENING:

 Dress wounds.
 Immobilise any large wounds and fractures.

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 Place the casualty in the most comfortable position consistent with the requirements of treatment.

TO PROMOTE RECOVERY:

 Relieve the casualty of anxiety and encourage confidence.

 Attempt to relieve the casualty of pain and discomfort.
 Handle the casualty gently.
 Protect the casualty from the cold and wet.

DISPOSAL OF THE CASUALTY

After you have carried out your treatment the casualty should normally receive attention from a qualified
person (doctor or nurse) without delay. Depending on the severity of the condition and the availability of
skilled help you should:

 Arrange transport to hospital by ambulance (or by car for minor injuries and arm fractures).
 Hand over the casualty to the care of a doctor or nurse at the scene.
 Take the casualty to a nearby house or shelter to await the arrival of the ambulance or doctor.
 Allow the casualty to go home and advice to seek medical advice, if necessary.

Never send anyone home who has been unconscious, even for a short time, or
who is in shock, seek medical aid.

3. RESUSCITATION

If a casualty is not breathing and if the heart is not beating, it is vital that you take over ventilation and
circulation so that the flow of oxygen to the brain is maintained. First ensure an open airway; second, breathe
for the casualty inflating the lungs and oxygenating the blood (Artificial Ventilation); third, circulate the blood
by compressing the chest (External Chest Compression). The quick and efficient use of Artificial Ventilation, if
necessary combined wit h External Chest Compression, should preserve
the casualty's life until more skilled help is available. Resuscitation should be attempt even if you are in doubt

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about whether a casualty is capable of being revived, you should always continue until: spontaneous breathing
and pulse are restored; another qualified person takes over; a doctor assumes responsibility for the casualty; or
you are exhausted and unable to continue.

If a casualty is unconscious, the airway may be narrowed or blocked making breathing noisy or impossible.
This occurs for several reasons: the head may tilt forward narrowing the air passage; muscular control in the
throat will be lost, which may allow the tongue to sag back and block the air passage; and, because the reflexes
are impaired, saliva or vomit may lie in the back of the throat blocking the airway.
Any of these situations can lead to the death of the casualty so it is imperative that you establish a clear airway
immediately.

Once the airway is open, the casualty may begin breathing spontaneously. If she does begin breathing, place in
the Recovery Position. If she still does not breathe, begin Artificial Ventilation immediately.

1. Kneel beside the casualty.

2. Lift her chin forwards with the index and middle fingers of one hand while pressing her forehead backwards
with the heel of your other hand. Her jaw will lift her tongue forward, clear of the airway. If the casualty's
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breathing is or becomes noisy, her airway is obstructed. Open and clear her airway immediately.

CHECKING BREATHING
In order to find out whether an unconscious casualty is breathing, after first opening the airway, look, listen
and feel for any signs of respiration.

1. Continue holding the casualty's airway open (see below) and place your ear above her mouth and nose.

2. Look along her chest and abdomen If she is breathing, you will hear and feet any breaths on the side of your
face and see movement along her chest and abdomen. Take 5 seconds to determine if the casualty is breathing.

CLEARING THE AIRWAY

Even when you have opened the casualty's airway, foreign matter such as vomit, loose teeth or dentures,
or food may block the airway, thereby preventing the casualty from breathing. Any object that ca n is
seen or felt should therefore be removed if possible.

1. Turn the casualty onto her side, supporting the head with one hand.

2. Hook your first two fingers of the other hand and sweep round inside the mouth But, do not spend time
searching for hidden obstructions and make sure that you do not push any object further down the throat.

3 Check breathing again (see above).

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BREATHING

The technique of breathing for a casualty is known as Artificial Ventilation The most efficient method is to
transfer air from your own lungs into the casualty's, by blowing into them through tile mouth (Mouth-to Mouth
Ventilation).
MOUTH- TO-MOUTH VENTILATION
The air we exhale contains about 16 per cent oxygen which is more than is needed to sustain life. In Mouth-to-
Mouth Ventilation you blow air from your lungs into the casualty's mouth or nose (or mouth and nose together
in an infant) to fill the casualty's lungs. When you take your mouth away, the casualty will breathe out as the
elastic chest wall resumes its shape at rest. Mouth-to-Mouth Ventilation enables you to watch the casualty's
chest for movement, indicating that the lungs are being filled or that the casualty is breathing again naturally,
and to observe changes in the casualty's colour.

Mouth-to-Mouth Ventilation can be used by First Aiders of any age and in most circumstances It is easiest to
carry out if casualty is lying on his or her back, but it should be started immediately whatever position the
casualty happens to be in. The inflations must be given slowly, taking 1,5 to 2 seconds for each inflation. The
casualty may start breathing again at any stage but may need assistance until breathing settling down into the
normal rate. Mouth-to-Mouth Ventilation may not be suitable or possible in certain circumstances, if there are
very serious facial injuries; if the casualty is pinned face downwards; or if there is evidence of corrosive
substances around the mouth.

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ARTIFICIAL VENTILATION

In this technique, the nose is pinched so that air blown into the casualty’s mouth cannot escape through the
nasal passage, but is forced into the lungs.

CIRCULATION
It is pointless continuing Artificial Ventilation if the casualty's heart is not beating, because the oxygenated
blood will not be circulating After checking for breathing you must check carefully to see whether the heart is
beating (see below). Always remember that while it is sometimes acceptable to assist breathing, which is
failing, the heart action is easily upset, so never attempt External Chest Compression if the heart is beating,
even faintly, and any pulse is felt.

EXTERNAL CHEST COMPRESSION

Contractions can be simulated in a non-beating heart by compressing the chest. By pressing down on to the
lower half of the breastbone you increase the pressure inside the chest thus driving blood out of the heart and
into the arteries. When you release the pressure, the chest returns to its normal position and blood flows back
along the veins and refills the heart as it expands. External Chest Compression is always
preceded, and accompanied, by Artificial Ventilation. To be effective, it must be carried out with the casualty
lying on a firm surface As soon as you feel a spontaneous pulse returning to the carotid artery stop External
Chest Compression immediately, but carry on with Artificial Ventilation on its own, if it is necessary.

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CHECKING FOR CIRCULATION
Before commencing External Chest Compression it is very important that you establish that there is no
circulation.

Although the casualty may be blue around the lips (cyanosed) if the heart is not pumping blood to the surface,
the only reliable way of establishing a lack of circulation is to check the pulse at the neck (carotid pulse). This
pulse can be felt by placing your fingertips gently on the voice box and sliding them down into the hollow
between the voice box and the adjoining muscle. Take 5 seconds to check for the presence of a pulse. It will
only return spontaneously if the heart is beating.

THE CAROTID PULSE

This is the wave of pressure, which passes along the carotid artery as the heart beats.

MOUTH-TO-MOUTH VENTILATION
This is the preferred method of Artificial Ventilation in all cases where a casualty is not breathing. If the mouth
cannot be used, satisfactory ventilation can be achieved through the nose (Mouth-to Nose) or through the
mouth and nose in small children and infants (Mouth-to-Mouth-and-Nose).

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Give the inflations as soon as possible not s end time Iooking for hidden obstructions.

1. Remove any obvious obstructions over the face or obstructions around the neck. Open the airway and
remove any debris seen in the mouth and throat.

2. Open your mouth wide, take a deep breath, pinch the casualty s nostrils together with your fingers and seal
your lips around his mouth.

MOUTH-TO-NOSE VENTILATION

If it is not possible to carry out Mouth 40-Mouth Ventilation, close the casualty's mouth with your thumb and
seal your lips about his nose. Proceed as for Mouth-to-Mouth Ventilation (steps 3-5).

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3. Blow into the casualty's lungs, taking 1,5 - 2 seconds and looking until you can see his chest rise to
maximum expansion.

If the casualty's chest fails to rise, first assume his airway is not fully open. Adjust the position of his head and
chin and try again. If there is still no ventilation, his airway may be blocked, and you will have to treat for
Choking.

4. Remove your mouth well away from the casualty's and breathe out any excess air while watching his chest
fall. Take a deep breath. Repeat inflation.

5. After the first ten inflations (approximately 1 minute), check the pulse to make sure the heart is beating.

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If the hear is beating and a pulse is felt, continue to give inflations at a rate of 10-12 times per minute
(approximately 1 inflation every 5 seconds) until natural breathing is restored, assisting it when necessary and
adjusting it to the casualty’s breathing rate.

When the casualty is breathing independently, place him in the Recovery Position.
If the heart is not beating you must send for the Emergency Medical Services and
commence External Chest Compression immediately after the first two inflations.
EXTERNAL CHEST COMPRESSION

If mouth-to-mouth ventilation by itself is unsuccessful and the casualty’s heart stops, or has stopped beating,
you must perform External Chest Compression in conjunction with Mouth-to-Mouth Ventilation. This is
because without the heart to circulate the blood, oxygenated blood cannot reach the casualty’s brain.

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 1. Lay the casualty on his back on a firm surface. Kneel along side him facing his chest and in line with his
heart. Find the junction of his rib margins at the bottom of his breastbone. Place the heel of one hand along
the line of the breastbone, two finger breaths above this point, keeping your fingers off the ribs.

2. Cover this hand with the heel of the other hand and interlock your fingers. Your fingers should be directly
over the casualty’s breastbone and your arms straight.
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 3. Keeping your arms straight, press down vertically on the lower half of his breastbone to move it 4-5 cm
(1.5 –2 inches) for the average adult. Release pressure.

Complete 15 compressions at the rate of 80 compressions per minute. Compressions should be regular and
smooth, not jerky and jabbing. (To find the correct speed, count one and two and three, and so on.)

4. Move back to the casualty’s head, re-open his airway, and give two breaths of Mouth-to-Mouth
Ventilation.

5. Continue with 15 compressions, followed by two full ventilations, repeating the circulation check after
the first minute. Thereafter, check pulse after every three minutes.
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 6. As soon as the pulse returns, stop compressions immediately. Continue Mouth-to-Mouth Ventilation until
natural breathing is restored, assisting it when necessary, and adjusting it to the casualty’s rate. Place the
casualty in the Recovery Position.

Note: When resuscitation is successful, the carotid pulse will return. Look at the casualty’s face and lips.
The colour will improve as blood containing oxygen begins to circulate. When the casualty is not breathing,
the normal colour turns to blue (cyanosis)

4. RESUSCITATION WITH TWO FIRST AIDERS

When two first aiders are present, one should take charge and maintain the open airway, perform Mouth-to-
Mouth Ventilation and check circulation; the other should perform external chest compression. If
resuscitation is prolonged, the First Aiders can change places to reduce the strain, and it may be easier if
they work on opposite sides of the body.

1. One first aider takes up a position at the casualty’s head; the other kneels alongside the casualty, level
with the middle of her chest.

2. The first aider at the head immediately opens the airway and gives the first two inflations. The first aid
begins chest compression.

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 3. Resuscitation then continues with the First Aider at the head keeping the airway open and giving a single
inflation on the upstroke of every fifth compression by the partner. The compressions are continued at a rate
of 80 per minute until the circulation returns and the pulse is felt.

Pulse check must be carried out after the first minute and then every three minutes.

Note: There needs to be a short pause after every five compressions, allowing time for the lungs to inflate

5. REPORTING ON THE CASUALTY

The casualty should always be accompanied by a brief written report when he/she leaves your care. If
necessary, you should accompany the casualty yourself and make a personal report. The need to supply
complete information cannot be emphasized enough, and it should include the following:

 History of the incident or illness.

 Brief description of injury.
 The level of responsiveness and changes.
 Any other associated injuries. The pulse and any changes.
 The skin colour and any changes. Blood loss sustained.
 Any unusual behaviour by the casualty.
 Any treatment given and when.
You should also send a tactful message to the casualty’s home stating what has happened and where the
casualty has been taken if the police or other authority attending the incident has not already done this.

PROPERTY
Take care of any property belonging to the casualty and hand it over to the police or ambulance personnel.

DEALING WITH CLOTHES AND HELMETS

Sometimes it is necessary to remove clothing in order to expose injuries, make an accurate diagnosis or conduct
a proper treatment. This should be done with the minimum of disturbance to the casualty and clothing and only

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remove as much as is actually necessary. Clothing should not be damaged unnecessarily. If very tight
underclothing, such as a girdle, has to be cut, do this along the seams, if it is possible. If you need to remove the
casualty’s clothing ensure that sufficient privacy is maintained.

SESSION 2.
Demonstrate an advanced level of preparedness to deal with
potential emergencies.

Learning Outcomes
 Legal responsibilities are identified and explained in accordance with relevant current legislation and
associated regulations.
 The legislated rescue and first aid equipment and any additional applicable risk based equipment is
identified and demonstrated in accordance with specific given uses.
 Emergency equipment storage and maintenance is described and demonstrated according to required
specifications and accessibility for use.
 The level of preparedness demonstrated is applicable to the specific risk site.

Advanced level of preparedness to deal with potential emergencies

Advanced Level of Planning Preparedness
The Advanced Level of Planning Preparedness is the highest level of planning preparedness, and demonstrates
the greatest capability to respond to and manage emergencies and disasters.
The importance of an effective workplace safety and health program cannot be overemphasized. There are
many benefits from such a program, including increased productivity, improved employee morale, reduced
absenteeism and illness, and reduced workers' compensation rates. Unfortunately, workplace accidents and
illnesses still occur in spite of efforts to prevent them, and proper planning is necessary to effectively respond
to emergencies.
To conduct business normally, it is important for the clinic to have a strategy on preparation for emergencies.
This plan must provide a clinic or organizational structure so that the clinic can effectively prepare for both
external and internal disasters that can negatively affect its environment of care.
Ongoing disasters, new standards by healthcare accreditation and regulatory bodies, and the general sense that
emergency preparedness and disaster planning has been neglected by some healthcare systems has driven the
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need for individuals with specialized skills to address emergency preparedness and medical disaster planning in
hospitals and health care systems. This program will provide participants with current information on a
variety of topics to better address emergency management for hospitals and healthcare systems before, during
and after disasters.
Objectives:
Information presented should improve ability to:
 perform functions essential to hospital/healthcare system emergency management and medical
disaster planning.
 interpret the Emergency Support Function 8 under the National Response Framework.
 Discuss the rules, guidelines, regulations, and statutory requirements for healthcare systems.
 Design an emergency operations plan.
 Create disaster specialty teams.
Disaster preparedness planning involves identifying organisational resources, determining roles and
responsibilities, developing policies and procedures and planning activities in order to reach a level of
preparedness to be able to respond timely and effectively to a disaster should one occur. The actual planning
process is preliminary in nature and is performed in a state of uncertainty until an actual emergency or disaster
occurs. After a disaster occurs, plans must be adapted to the actual situation.
The information offered in this module should serve as a guideline, rather than a blueprint, for preparedness
planning. Planning priorities are different depending on the specific organization and organizational level at
which the plan is developed. It is best to work on preparedness plans in consultation and cooperation with those
who will have to implement or approve them. National Societies should have a definite level of preparedness
and a corresponding level of planning. Agencies with different resource levels can choose the planning
elements that best suit their needs. At the community level, Red Cross/Red Crescent Societies can play a useful
role in supporting the organization of disaster planning committees who can be responsible for developing a
community disaster preparedness plan. The annexes to this module include preparedness plan outlines that can
be modified for use at the National Society or community level and tools to use when developing a plan.
The need for preparedness planning
The concept of preparedness planning is very important for those involved in disaster
management. During an actual emergency, quick and effective action is required; however, this action often
depends on having plans in place before a disaster strikes. If appropriate action is not taken or if the response is
delayed, lives will be needlessly lost. In a preliminary plan, even though the details of a disaster remain
uncertain, you can identify emergency shelter sites, plan and publicise evacuation routes, identify emergency
water sources, determine chains of command and communication procedures, train response personnel and
educate people about what to do in case of an emergency. All of these measures will go a long way to improve
the quality, timeliness and effectiveness of the response to a disaster.
Because of its future-oriented nature, preparedness planning is more difficult than planning an emergency
operation in response to an actual disaster. Frequent obstacles include:
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 resistance to planning because it diverts attention and scarce resources away from ongoing work to plan for
an event that may not occur
 political pressure on decision makers not to address or acknowledge possible disaster scenarios.
A preparedness plan should list the name(s), responsibilities during emergency, and contact numbers and
addresses for the emergency response focal point, the team members at each operational level and people in
charge of:
 Activating the response services
 Communicating with headquarters
 Managing external relations and aid appeals from other sources, including
 governmental, international and public funds
 Communicating with the media
 Coordinating and liasing with other agencies and services
 Managing administrative work
The legislated rescue and first aid equipment and any additional applicable risk based equipment
In the event of injury or sudden illness, failure to provide first aid could result in a casualty’s death. The
employer should ensure that an employee who is injured or taken ill at work receives immediate attention.
Medical emergencies can happen at any time. That is why healthcare professionals recommend first aid kits for
homes, offices, vehicles and at the workplace. The best solution is to be prepared and to have a first aid kit
handy at all times. First aid kits are a collection of supplies and equipment used to provide first aid. These kits
have different uses and may have different contents depending on the purpose. However, all first aid kits
include items to perform basic first aid that ranges from minor injuries such as cuts, sprains and bites through to
more serious injuries involving major trauma, heavy bleeding and CPR.
What You'll Need
Include the following in each of your first-aid kits:
 first-aid manual
 sterile gauze pads of different sizes
 adhesive tape
 adhesive bandages in several sizes
 elastic bandage
 a splint
 antiseptic wipes
 soap
 antibiotic ointment
 antiseptic solution (like hydrogen peroxide)
 hydrocortisone cream (1%)
 acetaminophen and ibuprofen

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 extra prescription medications (if the family is going on vacation)
 tweezers
 sharp scissors

 safety pins
 disposable instant cold packs
 calamine lotion
 alcohol wipes or ethyl alcohol
 thermometer
 tooth preservation kit
 plastic non-latex gloves (at least 2 pairs)
 flashlight and extra batteries
 a blanket
 mouthpiece for administering CPR (can be obtained from your local Red Cross)
 your list of emergency phone numbers
 blanket (stored nearby)
Emergency equipment storage and maintenance
Emergency Equipment Storage signs notify employees and visitors of special safety equipment should it be
needed.

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 Store first-aid kits in places that are out of children's reach but easily accessible for adults.

The level of preparedness demonstrated is applicable to the specific risk site.

In all communities, health systems and assets are vital components of the critical infrastructure and provide
tremendous social and economic benefits. In a disaster, the incapacity or destruction of such systems and assets
would have an immediate, debilitating impact on local medical and public health programs and services, as well
as on economic security. Adequate response and recovery in a disaster cannot occur
without a fully resourced, protected and connected health system that functions effectively on a day-today
basis. Government agencies at the federal, state and local levels need to understand that the viability of this
system is an essential part of a community’s critical infrastructure. Targeted and sustained investment in
enhanced health system preparedness for disasters serves as an engine for economic growth and development
before an event occurs, as well as post-event for community redevelopment and recovery.

SESSION 3.
Assess and manage a complex emergency scene/disaster.

Learning Outcomes
 Potential disasters are identified in terms of their likelihood of occurrence.
 The principles and implementation methods of the situational disaster management plans are explained
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 in terms of activation, establishment and maintenance.
 The potential health hazards that may result from a complex emergency scene/disaster are assessed and
explained in terms of the causes identified.
 The method of triage is explained in accordance with the accepted international codes.
 Mobilization activities for emergency services, relevant to the place of occurrence and the specific needs
are identified and explained.
 Secondary patient assessment and continual care is explained and demonstrated.

Assess and manage a complex emergency scene/disaster.

What is Emergency Management? To some, it is a disciple, to others, a process. I look at emergency
management as a process, under the elected leadership, where communities manage complex emergencies and
disasters. It is that ability to manage these events that separates emergency management from respond
organizations. Fire, Law Enforcement, EMS, even Public Works is the subject matter experts in their fields. But
they rarely work daily as teams in dealing with complex events. Nor do they generally work with the elected
leadership of a community in their daily responses.
Some disasters can result from several different hazards or, more often, to a complex combination of both
natural and man-made causes and different causes of vulnerability. Food insecurity, epidemics, conflicts and
displaced populations are examples.
Potential disasters are identified in terms of their likelihood of occurrence.
Disasters such as earthquakes, tsunamis, volcanic eruptions, floods and storms can strike at any time,
sometimes without warning. All disasters have the potential to cause disruption, damage property and take
lives.
Getting ready before an earthquake strikes will help reduce damage to your home and business and help you
survive.
 Develop a Household Emergency Plan. Assemble and maintain your emergency survival Items for your
home and workplace, as well as a portable getaway kit.
 Practice Drop, Cover and Hold.

 Identify safe places within your home, school or workplace. See the right-hand panel for more information
about safe places.
 Check your household insurance policy for cover and amount.
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 Seek qualified advice to make sure your house is secured to its foundations and ensure any renovations
comply with the New Zealand Building Code.
Floods are usually caused by continuous heavy rain or thunderstorms but can also result from tsunami and
coastal storm inundation. A flood becomes dangerous if:
 the water is very deep or travelling very fast
 the floods have risen very quickly
 the floodwater contains debris, such as trees and sheets of corrugated iron
Getting ready before a flood strikes will help reduce damage to your home and business and help you survive.
BEFORE A FLOOD
 Find out from your local council if your home or business is at risk from flooding. Ask about evacuation
plans and local public alerting systems; how you can reduce the risk of future flooding to your home or
business; and what to do with your pets and livestock if you have to evacuate.
 Know where the closest high ground is and how to get there.
 Develop a Household Emergency Plan. Assemble and maintain your Emergency for your home as well as a
portable getaway kit.
 Check your insurance policy to ensure you have sufficient cover.
Heavy rainfall or earthquakes can cause a landslide. Human activity, such as removal of trees and vegetation,
steep roadside cuttings or leaking water pipes can also cause landslides. Most landslides occur without public
warning and it’s important to recognise the warning signs and act quickly.
BEFORE A LANDSLIDE
Getting ready before a landslide will help reduce damage to your home and business and help you survive.
 Find out from your council if there have been landslides in your area before and where they might occur
again
 Check for signs that the ground may be moving.
See the right-hand panel for a list of warning signs
 Be alert when driving especially where there are embankments along roadsides. Watch the road for
collapsed pavements, mud and fallen rocks.

The principles and implementation methods of the situational disaster management plans.
The following principles need to be considered when shaping a vision and guiding strategy to deal with
disasters:
It must focus on key issues
As sustainable development is one of the main goals in South Africa, reduction of vulnerability of communities
must be the primary focus and not disaster relief. Disaster management offers a collective safety net that has the
potential to protect development processes against those setbacks that wound development in many countries,
frequently through natural and man-made disasters.
Taking care of the most vulnerable first
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The first priority of disaster management is the protection of the people who are most at risk. The second
priority is the protection of the critical resources and systems on which communities depend.
Foster a culture of prevention
Government will encourage both citizens and government structures to protect themselves and their property to
the best of their ability at all times. It will not provide assistance to citizens who have failed to take proper
precautions.
Integration into development
Disaster prevention and preparedness should be an integral part of every development policy.
Equity
Disaster assistance must be provided in an equitable, consistent and predictable manner without regard to
economic circumstances, industry or geographic location.
It must ensure community involvement
Communities must know what disaster management and risk reduction stand for, what their own
responsibilities are, how they can help prevent disasters, how they must react during a disaster (and why) and
what they can do to support themselves and relief workers, when necessary.
It must be driven in all spheres of government
Disasters know no boundaries. Unless disaster management and risk reduction are effectively driven at central,
provincial and local government level and are made compulsory, disasters that impact on a region or country
will be extremely difficult and costly to address.
It must be transparent and inclusive
Disaster management and risk reduction require transparency in the way decisions are made and information is
exchanged. They must also be inclusive, ensuring that all parties responsible for implementing the ongoing
programme or any of its phases, are consulted; this includes private enterprise, unions, non-governmental
organisations and community-based organisations.
It must accommodate local conditions
Any efforts could be ineffective if proposals/guidelines are accepted or implemented without ensuring that they
are adapted to address local conditions, which differ widely from community to community.
It must have legitimacy
The structures tasked with implementing a disaster-management programme must be recognised by all present
and future key roleplayers in the various government structures, as well as among the various community
structures with whom liaison is necessary.
It must be flexible and adaptable
Flexibility and adaptability must be allowed for, to take into account the rapid changes brought about by
modern development, as well as external factors that might pose a threat or have an impact on the functioning
of the programme. Rapid changes in community structures and the general development of an area - i.e., new
industries and residential areas and environmental changes require adaptation to planning and allocation of
priorities, without which applied principles will become outdated and cause frustration.
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It must be efficient and effective
Unless disaster management is results-driven, in all spheres of government, it is in danger of becoming
sidelined, which could in turn become costly should a disaster occur.
It must be affordable and sustainable
The allocation of funds is an important issue. Hopefully, funds allocated to the ongoing proactive facets of the
disaster-management cycle will mean that funds will be required less often to coordinate disaster relief.
It must be needs-orientated and prioritised
Many existing essential and emergency services find it difficult to accept the necessity for disaster
management. If the concept is understood, and is seen to address real present and future needs, it will gain
acceptance and receive the correct priority it deserves.
It must be based on a multi-disciplinary and integrated approach
Disasters are social phenomena, as much as physical or economic events. Disaster reduction is thus a multi-
disciplinary process that includes environment, human settlement, human behaviour, health and public
administration considerations. Only an integrated approach can have success.
Taking care of the most vulnerable first
The first priority of disaster management is the protection of the people who are most at risk. The second
priority is the protection of the critical resources and systems on which communities depend.
Foster a culture of prevention
Government will encourage both citizens and government structures to protect themselves and their property to
the best of their ability at all times. It will not provide assistance to citizens who have failed to take proper
precautions.
Integration into development
Disaster prevention and preparedness should be an integral part of every development policy.
Equity
Disaster assistance must be provided in an equitable, consistent and predictable manner without regard to
economic circumstances, industry or geographic location.
It must ensure community involvement
Communities must know what disaster management and risk reduction stand for, what their own
responsibilities are, how they can help prevent disasters, how they must react during a disaster (and why) and
what they can do to support themselves and relief workers, when necessary.
It must be driven in all spheres of government
Disasters know no boundaries. Unless disaster management and risk reduction are effectively driven at central,
provincial and local government level and are made compulsory, disasters that impact on a region or country
will be extremely difficult and costly to address.
It must be transparent and inclusive
Disaster management and risk reduction require transparency in the way decisions are made and information is
exchanged. They must also be inclusive, ensuring that all parties responsible for implementing the ongoing
41 | P a g e
programme or any of its phases, are consulted; this includes private enterprise, unions, non-governmental
organisations and community-based organisations.
It must accommodate local conditions
Any efforts could be ineffective if proposals/guidelines are accepted or implemented without ensuring that they
are adapted to address local conditions, which differ widely from community to community.
It must have legitimacy
The structures tasked with implementing a disaster-management programme must be recognised by all present
and future key roleplayers in the various government structures, as well as among the various community
structures with whom liaison is necessary.
It must be flexible and adaptable
Flexibility and adaptability must be allowed for, to take into account the rapid changes brought about by
modern development, as well as external factors that might pose a threat or have an impact on the functioning
of the programme. Rapid changes in community structures and the general development of an area - i.e., new
industries and residential areas and environmental changes require adaptation to planning and allocation of
priorities, without which applied principles will become outdated and cause frustration.
It must be efficient and effective
Unless disaster management is results-driven, in all spheres of government, it is in danger of becoming
sidelined, which could in turn become costly should a disaster occur.
It must be affordable and sustainable
The allocation of funds is an important issue. Hopefully, funds allocated to the ongoing proactive facets of the
disaster-management cycle will mean that funds will be required less often to coordinate disaster relief.
It must be needs-orientated and prioritised
Many existing essential and emergency services find it difficult to accept the necessity for disaster
management. If the concept is understood, and is seen to address real present and future needs, it will gain
acceptance and receive the correct priority it deserves.
It must be based on a multi-disciplinary and integrated approach
Disasters are social phenomena, as much as physical or economic events. Disaster reduction is thus a multi-
disciplinary process, that includes environment, human settlement, human behaviour, health and public
administration considerations. Only an integrated approach can have success.

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A new model for disaster management
In this alternative view of disaster management - the expand-contract model - disaster management is seen as a
continuous process. Disasters are managed in a parallel series of activities rather than in a sequence of actions.
The different strands of activities or actions continue side by side, expanding or contracting as needed.
For example, immediately after a disaster event - such as a flood - the "relief and response" strand will expand
to cope with the immediate effects of the disaster. But as time passes, the "recovery and rehabilitation" strand -
including prevention to mitigate against possible future disasters - will expand to address the rehabilitation
needs of the affected community. The relative weighting of the different strands will also vary depending on the
relationship between the hazard event and the vulnerability of the community involved.
This approach acknowledges that disaster management usually includes a number of interventions and actions
that may be occurring simultaneously (at the same time) and not always in phased succession (one after the
other). In the case of droughts, for example, drought relief, recovery and mitigation may often occur at the same
time.
Despite the existence of different approaches to disaster management, disasters are often managed haphazardly.
The approach taken to disasters may thus be as costly (or even more costly) than the event itself. People are
unprepared, and when the event occurs (even slow-onset disasters) it usually triggers haphazard reactions,
which often result in crisis management. Awareness of disasters and of one's vulnerability to such events can,
however, reduce the impacts of such events.
Community involvement must always be part of the disaster management approach. The importance of
community involvement can best be described with an example.
Awareness and mitigation can reduce disaster impacts

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Community awareness of disasters can greatly reduce the overall costs of such events. In Laingsburg in 1981
people had not previously experienced severe flooding and were therefore completely unprepared when a
severe flood hit the town. As a result of this unpreparedness, 104 lives were lost during the flood.
By contrast, the floods which struck Ladysmith in 1994 caused relatively little loss of life. This was largely
because the low-lying areas around Ladysmith are frequently flooded and the risk of disasters is higher. The
communty is therefore better prepared for the disaster and better able to limit its effects.
Note that awareness includes all the people concerned and not merely officials. Community awareness and
effective mitigation are therefore a critical element of disaster management.

Key elements of disaster management

Examples of disaster management strategies are provided below. These are not the only ways that disasters can
be managed and are only meant to prompt institutions dealing with disasters to become better prepared for
disasters.
Prevention
Government departments and municipalities can better prevent a disaster by conducting certain activities before
a disaster occurs. These can include constructing a dam or levee to control flood waters; or control burning-off
programmes in a veld fire area, and ensuring that there is proper socio-economic development and active
ownership and participation of communities along the disaster management continuum (all the phases of the
disaster management cycle).
Mitigation
Disaster mitigation refers to measures that can be taken to minimise destructive and disruptive effects of
hazards and thus lessen the scale of a possible disaster. Disaster mitigation can occur at any time.
A disaster plan and structure (e.g., disaster committee at the local level) should be established. Each plan will
be site or local specific and as such must be tailored for the municipalities concerned. For example, coastal
towns may develop a series of building codes so as to reduce losses in the event of heavy rains and strong
winds associated with a cyclone. Rural towns may have to plan for veld fires, droughts and improved water
management.
Disaster mitigation can be achieved through proper engineering, spatial planning, municipal management and
conflict resolution.
Preparedness
Preparedness measures such as the maintenance of inventories of resources and the training of personnel to
manage disasters are other essential components of managing a disaster. Furthermore, this should be an
ongoing, regular function of local government departments. These measures can be described as logistical
readiness to deal with disasters and can be enhanced by having response mechanisms and procedures,
rehearsals, developing long-term and short-term strategies, public education and building early warning
systems.
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Risk assessments (identifying those areas and people that may be at risk of a disaster before a disaster occurs)
are also essential and may complement development strategies in local areas. The development of "suitable"
housing for those living in urban, flood-prone areas cannot be undertaken without a risk assessment for
development (and flood-reduction) planning. Efforts do not therefore have to be doubled and the two
(development and disaster reduction) can occur simultaneously.
Preparedness can also take the form of ensuring that strategic reserves of food, equipment, water, medicines
and other essential material are maintained in cases of national or local catastrophes.
Response and relief
If a disaster does occur then response and relief have to take place immediately; there can be no delays. Delays
will occur if government departments and municipalities have no clear plans to manage such events. It is
therefore important to have contingency plans in place. Imagine the following scenario:
A flood has occurred in an area and there are also strong winds. Fear and chaos break out. Members of the
public are swamping emergency services with pleas for help and the mayor's reputation is on the line.
A well-managed team of government and local players should be prepared and know where to go, what to do...
If the situation is managed in a crisis way, then people rush off in all directions, waste valuable time, and even
make serious mistakes as a result of their actions.
Search and rescue plans need to be clear and all roleplayers need to know their role and function in such
activities. Basic needs such as shelter, water, food and medical care also have to be provided and a plan needs
to be in place (outlining who is responsible for such activities, etc.)
Rehabilitation
Interventions are also needed after a disaster occurs. In many ways this is the most difficult period for the
victims. Job-producing activities, construction works and public works programmes may be needed to name but
a few. The victims cannot be forgotten once the immediate disaster has passed.
Disaster management, as shown by these examples, requires effort and commitment by the various role players.
The capacity must be built to handle such events, and training programmes are essential. Duplication of efforts
should be minimised and financial resources appropriately controlled. In certain cases, the "expand and
contract" model is best, with local government personnel conducting disaster management in their everyday
activities and then "expanding" these when needed. It is important to note that disasters are non-routine events
that require non-routine response. Governments cannot rely on normal procedures to implement appropriate
responses - they will need to learn special skills, techniques and attitudes in dealing with disasters.
The key elements of disaster management listed above are important in providing governments with the
capacity to deal with disaster management at various stages. This is not an exhaustive list of areas, simply the
most important ones. A new system needs to incorporate some of these key elements into its management
plans.
The potential health hazards that may result from a complex emergency scene/disaster
The effects of disasters on health depend on the disaster’s type and time of onset. Sudden onset disasters such
as earthquakes pose greater threats to health than slow onset disasters. The actual and potential health problems
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resulting from the disaster are multifaceted and do not all occur at the same time. The resulting health problems
might be related to food and nutrition, water and sanitation, mental health, climatic exposure and shelter,
communicable diseases, health infrastructure and population displacement.
Disasters, whether natural or human-made, create particular problems for health services.
Damage to health infrastructure:
 Disasters can cause serious damage to health facilities, water supplies and sewage systems. The damage
can severely limit health systems’ provision of medical care to the population in the time of the greatest
immediate need. Structural damage to facilities poses a risk for both health care workers and patient
 The supply chain (medical equipment and pharmaceutical supplies) for the health facilities is often
temporarily disrupted;
 Limited road access makes it at least difficult for disaster victims to reach health care centres. Relief
organisations might also have difficulties reaching vulnerable opulations; and Pre-hospital coordination and
communication is crucial in emergency situations.
 Disrupted communication systems lead to a poor understanding of the various receiving facilities’, military
resources’ and relief organisations’ actual capacity.
 Consequently, the already limited resources are not effectively utilised to meet the demands.
Increased demands for medical attention:
 Climatic exposure because of rain or cold weather puts a particular strain on the health system;
 Inadequacy of food and nutrition exposes the population to malnutrition, particularly in the vulnerable
groups such as children and the elderly; and
 If there is a mass casualty incident, health systems can be quickly overwhelmed and left unable to cope
with the excessive demands.
Population displacement:
 A mass exodus from the emergency site places additional stress and demands on the host country, its
population, facilities and health services, particularly.
 Depending on the size of the population migration, the host facilities may not be able to cope with the new
burden, and
 Mass migration can introduce new diseases into the host community.
Major outbreaks of communicable diseases:
 While natural disasters do not always lead to massive infectious disease outbreaks, they do increase the risk
of disease transmission. The disruption of sanitation services and the failure to restore public health
programmes combined with the population density and displacement, all culminate in an increased risk for
disease outbreaks.
 The incidence of endemic vector-borne diseases may increase due to poor sanitation and the disruption of
vector control activities.
The method of triage
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Initial triage, using the categories of Immediate, Delayed, Minor, and Dead/Non-salvageable, will be assigned
to first-in responders other than law enforcement officers. Personnel assigned to triage will function
individually.

All possible victims involved in the incident are to be quickly examined and tagged whether they appear
injured or not injured. All victims must be tagged.

Personnel will perform the basic triage examination, categorize the patient, and attach the appropriate tag in 60
seconds or less.

Non-ambulatory casualties should be triaged where they lie, unless they are in an unsafe area that requires their
immediate movement.

Ambulatory patients are separated from the general group at the start of triage by stating “Anyone who can
walk…” followed by an area assignment to which the patients will walk.

Triage tags are attached to casualties near the head. The removed portions of the tag should be delivered to the
Medical Group/Medical Branch to assist in the determination of resource requirements.

Initial triage personnel will perform the following procedures and move to the next victim:
1. Open the obstructed airway
2. Stop arterial bleeding
3. Elevate lower extremities

Mobilization activities for emergency services, relevant to the place of occurrence and the specific needs.
Mobilization occurs “in response to an emergency or disaster situation that has exceeded the capabilities of
available local resources
Certain planned events (events “certain”) have the capacity to result in an emergency or disaster situation that
could exceed the capabilities of local resources. Additionally, the preparation for such events has the capacity
to exceed the capabilities of available local resources.
Proactive mobilization shall be used to provide the increased fire service capacity and capability deemed
necessary to meet preplanned management and control objectives for the event.
In the event of a proactive mobilization request, conditions of approval may be imposed, for example:
• No local or mutual aid fire service resources shall be eligible for cost reimbursement
• Only the state mobilization fire resources shall be under the control and direction of the Mobilization Incident
Commander (MIC), in keeping with the accepted Delegation of Authority
Secondary patient assessment and continual care
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Secondary Assessment - Objectives
 Conduct a more thorough examination than in the primary assessment
 Head to toe examination
 Identify and treat any missed life threatening conditions (treat as soon as found)
 Identify and treat non-life threatening conditions after the secondary assessment is complete
 Obtain vital signs
 Establish dialogue with patient and family, collect information and reassure
 Verify chief complaint, obtain list of allergies, medications, and medical history
 Report to paramedics
Overview
 Complete history, vital signs, and head to toe examination
 Reassess ABCs and look again for life threats
 Treat life threats as soon as found
 Treat other problems after the secondary survey
 Report to paramedics

Patient Interview – If the patient is alert ask SAMPLE. If the patient is not alert,
obtain history from family, friends or co-workers. If unable to obtain a patient history, move to vitals.
S – Signs (what you see i.e. pale, sweaty)
Symptoms (what the patient tells you i.e. nausea, pain)
A – Allergies (food, medications, environmental)
M – Medications (drug names, are they available?)
P – Past Medical History (cardiac, diabetes, seizures, surgeries, etc.)
L – Last Oral Intake (what time and solid or fluid?)
E – Events Leading Up To (what was the patient doing prior to the incident?)

If the patient is alert and experiencing pain, perform a pain assessment by asking OPQRST.

O – Onset (when and where did this start / happen?)

P – Provoke (what were you doing when this started? I.e. exercise brought on pain)
Q – Quality (can you describe the pain? i.e. sharp vs. dull, pressure, crushing)
R – Region / Radiation (where is the pain? does it go anywhere else?)
S – Severity (can you rate the pain on a scale from 1 to 10?)
T – Time (how long has this been going on? i.e. 3X this week)
Obtain a complete set of vitals to include pulse, respirations, blood pressure (if trained), skin condition, pupils
and level of awareness.
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VITALS
Pulse - Described by rate, rhythm and volume
Respirations - Described by rate, rhythm and volume
Blood Pressure - Taken by auscultation or palpation
Skin - Describe colour, temperature and condition
PEARL - Pupils are Equal and Reactive to Light
Level of Awareness - Is the patient oriented to person, place and time?

Now perform a thorough head to toe assessment. Remember, you are always monitoring the patient’s ABC’s
and any critical interventions implemented.
HEAD - Look for CLAPS-D & discharge from the
ears/nose/mouth.
- Feel for TICS-D.
NECK - Look for CLAPS-D and JVD.
- Feel for TICS-D and tracheal deviation.
CHEST / BACK - Look for CLAPS-D and Feel for TICS-D.
ABDOMEN - Look for CLAPS-D and pulsating masses. If no
pulsating
Masses are noted, feel for TICS-D and rigidity in 4
quadrants.
PELVIS - Look for CLAPS-D and signs of incontinence or
priapism.
- Feel for TICS-D in 3 planes.
LOWER LIMBS Hips to toes. Look for CLAPS-D.
- Feel for TICS-D &
circulation/sensation/strength/mobility.
UPPER LIMBS Shoulders to finger tips. Look for CLAPS-D.
- Feel for TICS-D &
circulation/sensation/strength/mobility.

 Note all non-life threatening injuries found and treat appropriately.

 Complete a second set of vital signs recording as you did for your baseline vitals for comparison. If time
permits, on-going vital signs check every 5 minutes after your second set of vitals. Record and document
all vitals and times they were taken.
 Document injuries, history, treatments (with results), and vitals taken to prepare report for EMS.

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 SESSION 4.
Explain the applied anatomy and physiology of the human body
systems and describe the emergency care management of disorders
and diseases relating to each physical system.

Learning Outcomes
 Applied anatomy and physiology of the various human body systems are explained in accordance with
scientifically accepted terminology.
 Common disorders and diseases relevant to each system of the body are identified and described in terms
of signs, symptoms and emergency care management.

Applied anatomy and physiology of the various human body systems

Anatomy and physiology are the sciences that most closely relate to the human body, enabling us to understand
ourselves and why our bodies work the way they do. Anatomy is the study of the form of the human body--the
shapes of the muscles, the number of bones, the cells that sustain life. Physiology is the study of the function of
these parts, such as how the muscles in your face work together to make a smile, or how parts of cells turn
sugar into energy. As form follows function, so the two sciences are intertwined and usually studied together.

Relationship between Anatomy & Physiology

Anatomy

 The two subsets of the study of anatomy are gross anatomy, meaning what can be seen by the naked
eye, and histology, the study of tissues, also called microscopic anatomy. In addition to viewing the
body either in total or through dissection, there are three other ways to examine gross anatomy:
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 palpation, or touching (such as feeling swollen lymph nodes); auscultation, or listening (as a doctor
may listen to the lungs using a stethoscope); and percussion, or tapping (such as hitting the knee to
check for reflexes). Imaging techniques such as x-rays or MRI (magnetic resonance imaging) can also
aid in anatomical examination.
Physiology
 Physiology is the study of how the parts of the anatomy function together to create and sustain life.
There are numerous sub disciplines of physiology such as neurophysiology (physiology of the nervous
system), endocrinology (physiology of hormones) and path physiology (how diseases work). Some
aspects of physiology can be observed and tested on the human body, but when that is not possible,
studies of other species lend information on the body. This is called comparative physiology, and it is
the basis for new drugs and procedures that must first be tested on animals before being deemed safe
for humans.
Applications
 Anatomy and physiology are required classes for nursing and medical degrees. They are also either
required or helpful for such health care fields as physical therapy, chiropractic and veterinary medicine.
In most schools it is one class stretched out over two semesters, and typically includes memorizing
every bone, muscle, joint and major blood vessel in the body.
Hierarchy
 Part of the study of anatomy and physiology involves the hierarchy of complexity. This shows how a
human being can be broken down into smaller and smaller levels of complexity. The whole person is
an organism. The organism is made up of organ systems, such as the respiratory system or digestive
system. Organ systems are made up of organs--for example, three organs of the digestive system are
the stomach, small intestine and large intestine. Organs are composed of tissues. For example, skin
(which is an organ of the integumentary system) contains epithelial, connective and nervous tissue.
Tissues are made up of different types and sizes of cells, which in turn contain organelles that perform
various functions within cells. Organelles are made up of molecules such as protein and DNA, which
are composed of atoms, the smallest particle with a unique chemical identity.
Life Processes
 Anatomy and physiology are the study of living organisms. Organisms that are alive have several
properties. These properties often form the basis of anatomical and physiological study. Some of those
properties are: organization; metabolism and excretion; movement and response to stimuli;
development (by differentiation or growth); reproduction; and homeostasis, or the organism's ability to
maintain internal stability.
Common disorders and diseases relevant to each system of the body
Human body diseases vary in both severity and diversity. Any body part or function can contract a disease or
have a disorder. We are more capable today than ever before of combating these diseases and medicine is
advancing every day.
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Below are articles on diseases and disorders:

Skin Disorders

The skin is susceptible to physical injury and to infection by bacteria, virus, fungi, and exposure to sunlight.
Rashes can be caused by allergic reactions and some skin disorders are hereditary.

Nervous System Disorders

Damage to the nervous system through physical injury or disease can impair both physical and mental function.
The nervous system can be affected by infections, injury, tumors, and degenerative conditions.

Cardiovascular Disorders

Common heart diseases include structural defects, damage due to restricted blood supply, heart muscle
disorders and viral infections. What we eat and the amount of exercise we get can affect our cardiovascular
system.

Infections and Immune Disorders

Our bodies can be infected by bacteria, viruses, fungi and protozoa. Our immune systems work to combat these
viruses. Our immune systems can also develop disorders and there are two types of immune system disorder;
allergies and autoimmune diseases where the immune system over reacts and immunodefficiency diseases
where it underacts and is too weak to cope with a threat.

Digestive Disorders

Problems with our digestive systems occur frequently mainly due to the food we consume. Viral infections and
cancer can also affect our digestive systems.

What is the nervous system?

The nervous system is a complex, sophisticated system that regulates and coordinates body activities. It is made
up of two major divisions, including the following:

 Central nervous system. This consists of the brain and spinal cord.
 Peripheral nervous system. This consists of all other neural elements.

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In addition to the brain and spinal cord, principal organs of the nervous system include the following:

 Eyes
 Ears
 Sensory organs of taste
 Sensory organs of smell
 Sensory receptors located in the skin, joints, muscles, and other parts of the body

What are some disorders of the nervous system?

The nervous system is vulnerable to various disorders. It can be damaged by the following:

 Trauma
 Infections
 Degeneration
 Structural defects
 Tumors
 Blood flow disruption
 Autoimmune disorders

Disorders of the nervous system

Disorders of the nervous system may involve the following:

 Vascular disorders, such as stroke, transient ischemic attack (TIA), subarachnoid hemorrhage, subdural
hemorrhage and hematoma, and extradural hemorrhage

 Infections, such as meningitis, encephalitis, polio, and epidural abscess

 Structural disorders, such as brain or spinal cord injury, Bell's palsy, cervical spondylosis, carpal tunnel
syndrome, brain or spinal cord tumors, peripheral neuropathy, and Guillain-Barré syndrome

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 Functional disorders, such as headache, epilepsy, dizziness, and neuralgia

 Degeneration, such as Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS),
Huntington's chorea, and Alzheimer's disease

Signs and symptoms of nervous system disorders

The following are the most common general signs and symptoms of a nervous system disorder. However, each
individual may experience symptoms differently. Symptoms may include:

 Persistent or sudden onset of a headache

 A headache that changes or is different
 Loss of feeling or tingling
 Weakness or loss of muscle strength
 Sudden loss of sight or double vision
 Memory loss
 Impaired mental ability
 Lack of coordination
 Muscle rigidity
 Tremors and seizures
 Back pain which radiates to the feet, toes, or other parts of the body
 Muscle wasting and slurred speech

The symptoms of a nervous system disorder may resemble other medical conditions or problems. Always
consult your doctor for a diagnosis.

Doctors who treat nervous system disorders

Doctors who treat nervous system disorders may have to spend a lot of time working with the patient before
making a probable diagnosis of the specific condition. Many times, this involves performing numerous tests to
eliminate other conditions, so that the probable diagnosis can be made.

Neurology Neurological surgery Rehabilitation for neurological

disorders
The branch of medicine that The branch of medicine that provides surgical
manages nervous system intervention for nervous system disorders is The branch of medicine that provides
disorders is called neurology. calledneurosurgery, or neurological surgery. rehabilitative care for patients with
The medical doctors who treat Surgeons who operate as a treatment team for nervous system disorders is
nervous system disorders are nervous system disorders are called neurological called physical medicine and
called neurologists. surgeons or neurosurgeons. rehabilitation. Doctors who work

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 with patients in the rehabilitation
process are called physiatrists.

Diseases & Disorders of the Muscular System

Some of the most common diseases and disorders of the muscular system include myopathies, chronic fatigue
syndrome, fibromyalgia, muscular dystrophy and compartment syndrome. Muscular system diseases are often
caused by problems with the central nervous system.

Myopathies

 Myopathies are muscle diseases that affect skeletal muscles and are caused by genetic problems or
metabolic disorders according to the Neurology Channel. Most types of myopathies results in weak
skeletal muscles and often develop at a young age.

Chronic Fatigue Syndrome

 Chronic fatigue syndrome is a syndrome that's still being researched by physicians and results in
extreme fatigue that doesn't go away with rest, according to the Mayo Clinic. Symptoms of chronic
fatigue syndrome include loss of memory, difficulty concentrating, fatigue, random muscle pain,
headaches, unrefreshing sleep and sore throats.

Fibromyalgia

 Fibromyalgia results in widespread pain throughout every muscle in a person's body. Approximately
2% of the entire US population is affected by fibromyalgia. Symptoms of fibromyalgia include joint
tenderness, fatigue problems, and sleep disturbances.

Muscular Dystrophy

 Muscular dystrophy is a genetic muscle disease that makes muscle fibers abnormally susceptible to
damage. Most types of muscular dystrophy are caused by the deficiency of a protein known as
dystrophin.

Compartment Syndrome

 Compartment syndrome is an uncommon exercised induced syndrome and causes pain, swelling and
sometimes disability in person's legs or arms. Compartment syndrome is more common among
seasoned athletes but can affect anyone.

Circulatory System Diseases and Disorders

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Prone to various medical problems, some of the circulatory system disorders are angina, arrhythmia,
atherosclerosis, congenital heart defect, cardiomyopathy, hypertension, hypercholesterolemia, peripheral
vascular system, and rheumatic heart disease.

The circulatory system is, no doubt, one of the most crucial organ systems, which is responsible for carrying
out certain vital activities. It comprises the blood, blood vessels, and heart. All these components play a major
role in the normal functioning of the human heart and the circulatory system as a whole. The heart pumps blood
to various organs via the blood vessels, during which oxygen and nutrients are distributed to the body parts.

As per medical researches, diseases and disorders of the circulatory system account to the highest mortality rate
as compared to other ailments. Both hereditary and genetic factors are responsible for causing human
circulatory system diseases. Nevertheless, with the current statistics claiming increased figures of heart and
circulation problems, it is very important for us to learn about the related problems.

The primary function of the circulatory system is to supply oxygen, hormones, and other essential nutrients to
the body cells and tissues. In this cycle, it also does the work of replacing carbon dioxide with oxygen. Any
disturbance or irregularity in this circulatory cycle leads to medical conditions, which may be mild to severe.
For your reference, the following is a list of circulatory system disorders.

Angina
Angina, characterized by severe and recurrent chest discomfort and pain, is caused due to lack of blood supply
and/or oxygen supply in the muscles of the heart. Basically, it is manifested as a complication caused by

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constriction of the blood vessels. Angina is often considered as a warning sign of an impending heart attack.
So, it should be brought to the doctor's attention as soon as possible.

Arrhythmia
The major symptom of cardiac arrhythmia is irregular heart rhythm, in which the heart beats abnormally, either
at a slower rate or faster rate. In most cases, it is found to be a congenital problem and results from a heart
defect. Based on the severity of arrhythmia, medication, surgical procedure, and implanting pacemakers are
adopted in order to regulate heart rhythm.

Atherosclerosis
Atherosclerosis is a blood circulation problem, resulting from accumulation of fatty deposits in the walls of the
blood vessels, especially arteries. In other words, arteries are primarily affected by atherosclerosis. Over a
period of time, the arterial walls harden and lose their elasticity. Complication of atherosclerosis include
cardiovascular disease and heart attack.

Cardiomyopathy
Another in the list of diseases and disorders of the circulatory system include cardiomyopathy, which is caused
due to weakening of the heart muscles or myocardium. In the early stages, the ventricular muscles or muscles
of the lower heart chamber are affected. If left untreated, it spreads to the upper heart muscles. In severe cases,
cardiomyopathy can result in congestive heart failure and at times, death.

Congenital Heart Defect

As the term goes, congenital heart defect is present at birth and may be mild or severe. The fetus may show
incomplete and/or abnormal development of the heart organ, causing symptoms like heart murmur in infants.
The exact cause of congenital heart disease is not known. In some cases, genetic problems cause this defect,
while others develop without any reason.

Coronary Artery Disease

Coronary artery disease, also known as coronary heart disease, is by far the most common disease of the
circulatory system diagnosed in adults. It is caused due to atherosclerosis, i.e., accumulation of plaque in the
coronary arterial walls, which indirectly impairs the blood supply to the heart. Coronary artery disease is the
leading cause of death all over the world.

Hypertension
Hypertension or high blood pressure another frequently diagnosed disorder of the circulatory system. Over
here, the blood pressure (systolic and diastolic) reading remains consistently higher than the normal
recommended level. If not addressed timely, hypertension causes damage to the heart and blood vessels,
thereby increasing the risk of heart attack and other heart diseases.
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Hypercholesterolemia
As the name signifies, hypercholesterolemia or high cholesterol is characterized by an elevated cholesterol
level. There are two primary types of cholesterol, namely, low-density lipoproteins (LDL) or bad cholesterol
and high-density lipoproteins (HDL) or good cholesterol. Presence of high amounts of bad cholesterol (LDL)
increases the risk for heart diseases and stroke.

Peripheral Vascular Disease

Peripheral vascular disease affects the blood circulation to the extreme portions of the body, including the arms
and legs. Peripheral artery disease is the most common type of peripheral vascular disease, which is the
deposition of fatty acids in the arterial walls. Symptoms of peripheral vascular disease are tingling, numbness,
and other complications.

Rheumatic Heart Disease

This is a complication rarely observed in children who have untreated rheumatic fever. What happens is, the
antibodies produced by the body in response to bacterial infection (Streptococcus) falsely attack the body parts,
including the cardiac valves and muscles. The symptoms of this ailment are no different from that of congestive
heart failure, thus treatment for both is proceeded in the similar way.

The increased statistics of circulatory system diseases is mainly contributed by today's hectic lifestyle, less
physical activity, and unhealthy eating habits. Consequently, obesity, stress, smoking, and other unhealthy
habits are major risk factors of circulatory system diseases. Early diagnosis, correct therapeutic intervention,
and following a healthy lifestyle are crucial for combating the diseases and disorders related to malfunctioning
of the circulatory system.

Immune System Diseases: List of Immune System Disorders

Immune system is the defense mechanism of the body against several diseases and infections. Naturally, a
malfunctioning immune system accounts for a long list of immune system disorders.

Immune system is the body's strongest and the most efficient mechanism of self defense against all sorts of
parasites. As soon as immune system encounters one, it sets in action and destroys it completely. There are
several harmful bacteria, viruses and other foreign bodies which have a high potential of inducing lethal
infections in human body. Our immune system produces special antibodies for each of these micro-organisms.
Thus, had it not been for our immune system, we would have all been victims of some infection or the other.
However, an ill-functioning immune system can play havoc in the body by causing plethora of diseases and
disorders.

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Immune System Diseases List

Diseases and disorders of immune system are categorized depending upon the activity of the immune system.
An overactive immune system has as much potential for inducing health hazards as an under active immune
system. Following is the list of immune system disorders, depending upon the activity of immune system.

Under Active Immune System

 Immune Deficiency Conditions

 SCID

 AIDS

Overactive Immune System

 Allergies (food, drug, insect sting, particular substance)

 Anaphylaxis

 Asthma

 Autoimmune Diseases

Other Immune System Disorders

 Chediak-Higashi Syndrome

 Common Variable Immunodeficiency

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  Hay Fever

 Hives

 HTLV

 Hyper-IgE Syndrome

 Hyper-IgM Syndrome

 Primary Immune Deficiency

 Selective IgA Deficiency

 Skin allergies

 X-Linked Agammaglobulinemia

Immune Deficiency Conditions: This is the largest group of immune system diseases and comprises variety of
diseases that suppress the immune system. Often, the cause of immune deficiency conditions is some
underlying chronic illness. Symptoms for immune deficiency conditions are same as that of the underlying
disease.

SCID: SCID is an immune system disorder which is hereditary. The cause of SCID is a series of genetic
abnormalities, particularly on the X chromosome. Several types of recurrent infections are common in people
suffering from SCID. Besides, they are also prone to meningitis, pneumonia, measles, chickenpox, oral
candida, cold sores, blood disorders, etc. Immune system diseases in children suffering from SCID, become
evident in first 3 months of birth.

AIDS: HIV/AIDS is a serious immune failure and a leading cause of death worldwide. AIDS occurs in the later
stages of progression of HIV and causes the immune system of the body to collapse completely. AIDS is
considered as a life-threatening, sexually transmitted disease, though it can be transmitted through the means of
blood transfusion as well. Chances of survival in AIDS patients are negligible, if diagnosed in later stages.
Immune system related symptoms for AIDS range from common cold and flu to serious ones like pneumonia
and cancer.

Allergies: Allergies can be defined as an aggravated immune response to a normally harmless substance. There
are myriad allergens such as pollen grains, mold spores, latex rubber and certain food items like peanuts or
drugs like penicillin etc., which can cause allergies. Often, there are more than one allergens responsible for
inducing allergic reactions in a person. Although, allergy symptoms are often of mild consequence, medical
intervention is advised to diagnose the underlying problem.
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Anaphylaxis: Anaphylaxis is a serious and extreme form of allergy. In this condition, the allergen such as
food, medication or insect bite acts as a trigger and causes a series of physical discomforts in a person. Itchy
rash, swollen throat and dropping blood pressure are some common symptoms of anaphylaxis. Anaphylaxis
may lead to an emergency, if not diagnosed and treated on time.

Asthma: Asthma, a chronic lung disorder, is caused due to inflammation of the air passage. Allergens, irritants
or even stimulants such as physical activity can trigger the inflammation and induce variety of discomforts in a
person. The symptoms of asthma include wheezing, coughing, shortness of breath, chest tightness, etc.

Autoimmune Diseases: Autoimmune diseases is a group of immune system disorders, in which the cells of
immune system misinterpret signals and start attacking its own body cells. Autoimmune diseases cause serious
health hazards in an individual. Autoimmune diseases can be considered as an altogether different category of
immune disorders.

Chediak-Higashi Syndrome: Chediak-Higashi syndrome is a rare autosomal recessive disorder which is

caused due to mutations in LYST gene. This syndrome affects all the major organs and halts their functioning.
It damages the cells of the immune system and renders them ineffective against micro-organisms and other
invaders. Thus, the person suffers from recurrent infections. Bone marrow transplant is the most effective and
successful treatment for patients with severe Chediak-Higashi syndrome. Alternatively, vitamins to boost
immune system can also be taken, if the condition is not severe. More on immune system boosters and foods
that boost immune system.

Common Variable Immunodeficiency: Common variable immunodeficiency syndrome results due to the
reduced number of anti bodies in the body. This disorder is mostly found in adult human beings. Although, it
may be present at the time of birth, the symptoms do not surface until the person enters his twenties. Symptoms
include bacterial infections of the ears, sinuses, bronchi and lungs. Painful swollen joints in the knee, ankle,
elbow or wrist are also common. Some patients may report enlarged lymph nodes, spleen, etc.

Hay Fever: Hay fever is pretty similar to allergies due to air-borne substances like pollen, mold spores or even
animal dander. It is also called allergic rhinitis and affects over 35 million people in US alone. The symptoms
include, runny nose, watery eyes, sneezing etc., which are pretty similar to cold. The symptoms remain as long
as you are in the contact of allergen.

Hives: Hives is the skin's response to an allergen. The allergen in this case is food or some plant. Wheals
develop on the surface of the skin, as a reaction to the allergen. These wheals are often itchy and rounded or flat
topped. Apart from the itchy elevated skin, the other symptoms for hives include swollen lips, tongue and face.
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HTLV: Human T-cell lymphotropic viruses (retroviruses), HTLV-I, HTLV-II seriously affect the human
immune system. They are most prevalent among drug users and people with multiple sex partners. People with
genital ulcers and a history of syphilis are also prone to HTLV. The mode of transmission of HTLV is through
intimate sexual contact, blood transfusion or during pregnancy.

Hyper-IgE Syndrome: Hyperimmunoglobulin E syndrome or Job syndrome is a group of variety of immune

disorders. This condition is characterized by recurrent staphylococcus infection and skin rashes, similar to
eczema. It is a genetic disorder and inheritance can be dominant or recessive. People with dominant hyper-IgE
syndrome are unable to lose their primary teeth and thus have two sets of teeth.

Hyper-IgM Syndrome: Hyper IgM is a rare immunodeficiency disease. In this condition, the immune system
fails to generate two types of antibodies, IgA and IgG. The cause of this disease is a defective gene in T-cells.
Due to this defect, the B cells do not get the signal to produce IgA and IgG anti bodies, and thus, continue
producing IgM antibodies.

Primary Immune Deficiency: Primary immunodeficiency diseases are a group of immune system diseases
caused due to genetic abnormalities. In this case, people are born with faulty immune system. The symptoms
and effects are same as that in AIDS, but unlike AIDS the cause is not acquired.

Selective IgA Deficiency: This is a special immunodeficiency in which the immune system fails to generate
antibodies of type IgA. These antibodies protect the body against infections of mucous membranes lining the
mouth and digestive tract. Obviously, in their absence, body is exposed to several infections of mucous
membrane.

Skin Allergies: Skin allergies are similar to any other allergy, only the immunological response is expressed
through skin. Skin allergies are again an aggravated response of the immune system to certain harmless
substances. Skin allergies are characterized by red, itchy skin upon which lesions and wheals develop.

X-Linked Agammaglobulinemia: X-Linked Agammaglobulinemia is a genetic disorder in which the body's

ability to fight against infections is hampered. The immune system does not produce enough antibodies to
combat infections. Naturally, the body falls prey to a plethora of infections.

The above list only takes major immune disorders into consideration. Apart from the above mentioned
disorders, there are several genetic and acquired immunodeficiency diseases that affect millions of people all
over the world. Since, immune system protects us from various infections and illnesses, special attempts must
be made towards strengthening it.

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 SESSION 5.
Apply primary emergency life support for adults, children and infants
according to current international and/or national protocols.

Learning Outcomes
 A primary survey is conducted; signs and symptoms are identified and recorded in terms of required
protocols.
 Methods of managing airway obstruction/choking are demonstrated.
 One/two rescuer CPR is explained and demonstrated with the use of barrier ventilation devices, utilizing
appropriately sized manikins.
 Recovery positions are demonstrated with and without spinal board and spider harness in accordance
with the safety and comfort of the patient.
 The patient is transported in terms of availability according to the conditions under which the incident
occurred.
 The need for oxygen therapy is explained, the administration is demonstrated and the dangers of open
oxygen elaborated.
 Pulse sites and pulse monitoring are explained and demonstrated in terms of on-going monitoring of the
condition of the patient.

Apply primary emergency life support for adults

A person's heart or breathing can stop as a result of a heart attack, drowning, an electric shock or other injuries.
If this happens, their organs don't receive a supply of oxygen-rich blood and this will soon lead to irreversible
damage.

Cardiopulmonary resuscitation (CPR) involves giving chest compressions and rescue breaths (mouth-to-mouth
breathing) to a person who has stopped breathing or whose heart has stopped. In some cases, this can restart the
heart and breathing. More commonly, for example after a heart attack, CPR circulates enough blood around the
body to slow down organ damage.

Emergency life support can make the difference between life and death. Giving CPR to someone whose heart
has stopped can double or even triple their chance of survival. If you aren’t trained in emergency life support
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then giving chest compressions only can increase the chance of survival.
A rapid response is a crucial part of emergency life support. This is called the ‘chain of survival’ and involves:

 early recognition of the emergency and calling for an ambulance – to prevent cardiac arrest
 immediately performing CPR if the casualty isn’t breathing – to buy time
 early defibrillation – to restart the heart
 early post-resuscitation care – to restore quality of life

WHAT TO DO IN AN EMERGENCY

Stay calm and remember you can only do your best. First, assess the situation and make sure the area is free of
hazards, particularly anything that may have caused the injury to the casualty, such as live overhead cables.
You should never put yourself at risk and if there is no one else present, then shout for help.

If you have had first aid training, let others know. Also nominate someone to stand by in case you need to ask
them to call for emergency help.

Once you have assessed the situation, it’s important to quickly check the casualty's responses by talking to him.
Ask him to perform an action – such as opening his eyes – as he may not be able to talk to you.

If the casualty responds, leave him in the position that you found him. If necessary, ask your nominated
bystander to call the emergency services and inform them that you have a conscious adult male who is
breathing. You should monitor his condition regularly until help arrives or he has recovered.

If you don’t get a response, gently tap his shoulders and continue to speak to him. Make sure that you direct
your voice to both ears. Don’t move the casualty’s head or neck. You will then need to check his airway and
breathing.

Airway
The casualty can only breathe if his airway is clear. An airway can be blocked when a person is unconscious
and their tongue falls to the back of their throat. To open a casualty’s airway, complete the following actions.

 Place two fingers under the point of his chin.

 Put your other hand on his forehead.
 Lift his jaw and tilt his head back slightly.
 Remove any obvious debris that might be blocking the airway.
HOW TO OPEN THE AIRWAYS

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Breathing
Next, keeping the airways open, check if the casualty is breathing normally in a continuous rhythmical way.

· Look to see if his chest is moving up and down.

· Listen for his breathing by placing your ear next to his mouth.
· Feel for the casualty's breath against your cheek.

You need to look, listen and feel for up to 10 seconds before deciding if the casualty is breathing normally.

If the casualty is breathing normally, then place him in the recovery position and frequently check his
breathing before you get emergency help. If the casualty isn’t breathing or isn’t breathing normally (for
example, if he takes infrequent gasps) you will need to get emergency help and then begin CPR. If the casualty
is a baby (up to one year) or a child (aged one to puberty) you should carry out one minute of CPR before
calling for emergency help.

Ask your nominated bystander to call for emergency help or, if you’re alone, then you should call. Only leave
the casualty if there is no other way of getting help. If the casualty isn’t breathing, tell the bystander to bring an
AED (automated external defibrillator) if available.

If you’re in any doubt as to whether or not the casualty’s breathing is normal, act as if he isn’t breathing.

Methods of managing airway obstruction/choking

Chocking (foreign body airway obstruction) is a life threatening emergency. Chest thrusts or back blows are
effective for relieving foreign body airway obstruction in conscious adults and children. Life threatening
complications associated with the use of abdominal thrusts have been reported in many situations, and therefore
are not recommended to be used. The use of back blows or chest thrusts should be used. These techniques
should be applied in rapid sequence until the obstruction is relieved. More than one technique may be needed.
There is no evidence if back blows or chest thrusts are more effective or which technique should be used first.
Would you know what to do if someone started choking? What about if it's a baby, or yourself? Choking is
caused by a foreign object that gets stuck in the throat and restricts airflow. Most often, choking is the result of
someone getting food stuck in the windpipe, or commonly in children, it occurs when toys, coins, or other small
objects become stuck in the throat or windpipe. Choking can also occur as a result of injury trauma, drinking
alcohol, disease, or from swelling after a severe allergic reaction.
Choking means that a person is unable to breathe or speak because the throat or windpipe is completely
obstructed. Without first aid, the lack of airflow can cause serious brain damage or even death by asphyxiation.
If you think someone is choking, here's what to do.
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Make sure the person is choking. It is important to be able to distinguish between partial and total airway
obstruction. If a person is not truly choking, and has partial airway obstruction, you are better off letting
him cough to remove the obstruction himself. Someone who is truly choking (total airway obstruction) will
display one or more of the following signs:
 The "choking sign" -- both hands clutched to the throat
 Being unable to talk
 The person cannot breathe effectively without difficulty, there will be no air movement
 Cannot cough effectively
 Noisy breathing
 Changes in skin color: blue lips and fingernails
 Eventual unconsciousness.
Signs that the obstruction is partial rather than total include:
 Able to speak, cry, respond to you
 Breathing is noisy, labored, or gasping, some air will come from the mouth
 Coughing, or making "crowing" noises
 Very agitated or anxious
 Skin goes paler, blue color.
Ask the person, "Are you choking?". If the person can respond to you verbally, wait. Someone who is truly
choking will not be able to speak. If they can speak, cough, breathe, or cry, the obstruction is partial. It is
important that you do not use back blows on a person who has partial airway obstruction because there is a risk
of lodging the previously semi-loose object even more deeply, potentially causing a total obstruction. If the
person responds:
 Reassure the person.
 Encourage the person to cough. Do not use back blows.
 Keep monitoring the situation.
 Call an ambulance if the obstruction is not relieved, or you can hear wheezing or noisy breathing.

If the person cannot respond, shout for help.

If there is someone nearby, tell him to call for emergency services.

If the person is conscious, communicate your intent to perform first aid.

It's best to make sure that someone who is conscious know what you plan to do; this will also give him an
opportunity let you know if your assistance is welcomed.

Administer first aid as described in the following steps immediately. Do not waste time calling emergency
services if you are the only person who can help the choking victim.

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Note that the following instructions apply to a person sitting or standing.

Administer up to 5 back blows using the heel of your hand.

 Take the bottom part (heel) of your hand and deliver 5 separate forceful strikes between the person's
shoulder blades.
 Keep the back blows separate. Try to dislodge the object with each one.
 Look for improvement after each one.
If the back blows fail, perform 5 abdominal thrusts (also known as the Heimlich maneuver).
 Get behind the victim.
 Wrap your arms around his waist.
 Take the underside of one fist and place it near the middle of the person's abdomen, with the thumb-side
against the abdomen, just above the navel and below the breastbone.
 Grasp that fist in your other hand.
 Give up to 5 separate, inward and upward thrusts. Continue until the obstruction is dislodged - check after
each thrust. Stop if the victim becomes unconscious.

If the obstruction has not been relieved, alternate between 5 back blows and 5 abdominal thrusts until
the object becomes unstuck.
Make sure the object is completely gone.
 If the person is able, ask the victim to spit it out and breathe without difficulty.

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 Perform a finger sweep on an unconscious or incapacitated person to remove the object from his mouth.
Grasp the person's tongue and and lower jaw and lift to open his mouth. Sweep the object out.

Check to see if normal breathing has returned. Once the object is gone, most people will return to breathing
normally. If normal breathing has not returned or if the person is unconscious, check the mouth and remove any
visible solid obstruction and begin cardiopulmonary. There may be some resistance to inflations until the object
is dislodged. Alternate between abdominal thrusts, checking the airway, and performing rescue breathing until
help arrives.
Management of foreign-body airway obstruction is a part of basic life support that consists of recognizing
respiratory arrest. It involves the use of abdominal thrusts which is a technique used for unblocking an
obstructed airway by giving forceful thrusts to the abdomen.
Symptoms of choking:
 Occurs while person is eating and suddenly becomes quiet with a look of alarm on his or her face.
 The victim cannot speak or breathe and becomes cyanotic.
 The victim may have poor (inadequate) air exchange initially as indicated by a weak ineffective cough,
high-pitched noise while inhaling, increased respiratory difficulty, and possible cyanosis. A partial
obstruction with poor air exchange should be treated as if it were a complete airway obstruction.
 The victim collapses (falls forward, passes out.)
One/two rescuer CPR is explained and demonstrated with the use of barrier ventilation devices, utilizing
appropriately sized manikins.
Two-Rescuer CPR If there are two people trained in CPR on the scene, one should perform chest
compressions while the other performs ventilations. The compression rate for two-rescuer CPR is the same
as it is for one-rescuerCPR: 80 to 100 compressions per minute. However, the compression-ventilation ratio
is 5 to 1, with a pause for ventilation of 1 ½ to 2 seconds consisting primarily of inspiration. Exhalation
occurs during chest compressions. Two-rescuer CPR should be performed with one rescuer positioned at the
chest area and the other positioned beside the victim’s head. The rescuers should be on opposite sides of the
victim to ease position changes when one rescuer gets tired. Changes should be made on cue without
interrupting the rhythm.
The victim’s condition must be monitored to assess the effectiveness of the rescue effort. The person
ventilating the patient assumes the responsibility formonitoring pulse and breathing. To assess the
effectiveness of the partner’s chest compressions, the rescuer should check the pulse during compressions. To
determine if the victim has resumed spontaneous breathing and circulation, chest compressions must
bestopped for 5 seconds at the end of the first minute (20cycles) and every few minutes thereafter.
Adult CPR with two rescuers is different from adult single rescuer CPR. First check for patient responsiveness
and normal breathing and contact emergency services. With two rescuers, the rescuer kneeling next to the
patient's chest performs chest compressions, while the rescuer at the patient's head does rescue breathing.

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Check for a pulse and begin CPR if the patient has no pulse and is not breathing normally. Perform 30
compressions at a rate of at least 100 per minute and a depth of at least 2 inches in the center of the chest. Once
five cycles of CPR are done, or after about 2 minutes, the rescuers should switch places so that the person doing
compressions is now doing rescue breaths, and vice versa.
Mouth to mouth
Kneel beside the patient's head. Maintain an open airway.
Take a breath, open your mouth as wide as possible and place it over the patient's slightly open mouth. Whilst
maintaining an open airway seal the patient's nostrils with first aider's cheek (or pinch patient's nose) and blow
to inflate the patient's lungs. Because the hand supporting the head sometimes comes forward some head tilt
may be lost and the airway may be obstructed. Pulling upwards with the hand on the chin helps to reduce the
lost head tilt.
For mouth to mouth breaths, it is reasonable to give each breath in a short time with a volume to achieve chest
rise regardless of the cause of cardiac arrest. Care should be taken not to over – inflate the chest.
Look for rise of the patient's chest during each inflation. If the chest does not rise, possible causes are:
 Obstruction in the airway (inadequate head tilt, jaw thrust, tongue or foreign material);
 Insufficient air being blown into lungs;
 Inadequate air seal around mouth and/or nose.
If the chest does not rise, ensure correct head tilt, adequate air seal and ventilation. Following inflation of the
lungs, lift your mouth from patient's mouth, turn your head towards the patient's chest and listen and feel for is
being exhausted from the mouth and nose.
CPR risk
No human studies have addressed the safety, effectiveness, or feasibility of using barriers devices to prevent
patient contact during first aider breathing. The risk of disease transmission is very low and initiating breathing
without barrier device is reasonable. If available, first aiders should consider using a barrier device. It is
recommended to use a CPR protective shield (barrier device). These can be purchased for most chemists and
first aid suppliers.

Chest compressions
Recognition of the need for Chest Compressions
First aiders should perform chest compressions for all patients who are unresponsive and not breathing
normally.

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First aiders should use unresponsiveness and absence of normal breathing to identify the need for CPR.
Checking for a pulse is unreliable and should not be performed to confirm the need for CPR.
Locating the site for chest compressions.
There is insufficient evidence for or against a specific hand position for chest compressions during CPR. For a
patient receiving chest compressions, place your hands on the lower half on sternum. First aider should place
the heel of their hand in the centre of the chest with the other hand on top. (The first aider should either link
their thumb around the wrist of lower hand or link the fingers together, to stop the top hand slipping). Avoid
compression beyond the lower limit of the sternum. Compression applied too high is ineffective and, if applied
too low may cause regurgitation and/or damage to internal organs.

Two-rescuer CPR should be performed with one rescuer positioned at the chest area and the other positioned
beside the victim's head. The rescuers should be on opposite sides of the victim to ease position changes when
one rescuer gets tired. Changes should be made on cue without interrupting the rhythm.
The victim's condition must be monitored to assess the effectiveness of the rescue effort. The person ventilating
the patient assumes the responsibility for monitoring pulse and breathing. To assess the effectiveness of the
partner's chest compressions, the rescuer should check the pulse during compressions. To determine if the
victim has resumed spontaneous breathing and circulation, chest compressions must be stopped for 5 seconds at
the end of the first minute (20 cycles) and every few minutes thereafter.
Recovery positions are demonstrated with and without spinal board and spider harness in accordance
with the safety and comfort of the patient.
This is the best position for a casualty who is unconscious and breathing. It keeps their airway open and allows
any vomit to drain onto the floor, so they don't choke on it.
1. Place arm nearest you at a right angle.

Move the other arm, as shown, with the back of their hand against their cheek. Then get hold of the knee
furthest from you and pull up until foot is flat on the floor.

Pull the knee towards you, keeping the person's hand pressed against their cheek, and position the leg at a right
angle.

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Make sure that the airway remains open by tilting the head back and lifting the chin. Check breathing.

Monitor the casualty's condition until help arrives.

If a person is unconscious but is breathing and has no other life-threatening conditions, they should be
placed in the recovery position.
Putting someone in the recovery position will ensure their airway remains clear and open. It also ensures that
any vomit or fluid will not cause them to choke.
To place someone in the recovery position:
 Roll a person on their side with their arms and upper leg at right angles to the body to support them.
 Tuck their upper hand under the side of their head so that their head is on the back of the hand.
 Open their airway by tilting the head back and lifting the chin.
 Monitor their breathing and pulse continuously.
 If their injuries allow you to, turn the person onto their other side after 30 minutes.
Spinal injury
If you think a person may have a spinal injury, do not attempt to move them until the emergency services reach
you, unless their airway is obstructed.
If it is necessary to open their airway, place your hands on either side of their face and gently lift their jaw with
your fingertips to open the airway. Take care not to move their neck.
You should suspect a spinal injury if the person:
 has a head injury, especially one where there has been a large blow on the back of the head, and is or has
been unconscious
 complains of severe pain in their neck or back
 won't move their neck
 feels weak, numb or paralysed
 has lost control of their limbs, bladder or bowels
 has a twisted neck or back
If you must move the person (for example, because they are vomiting, choking or in danger of further injury),
you need someone else to help you roll them.
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One person should be at the head and another along the side of the injured person. Work together to keep the
person's head, neck and back aligned while gently rolling the person onto one side.
The patient is transported in terms of availability according to the conditions under which the incident
occurred.
Moving a collapsed or injured patient:
The condition of a collapsed or inured patient may be worsened by movement, increasing pain, injury, blood
loss and shock. However, patients lying on a roadway/railway line etc may need to be moved to ensure safety.
A first aider should move a collapsed or injured Vitim:
 To ensure the safety of both first aider and the patient.
 Where extreme weather conditions or difficult terrain indicate that movement of the patient is essential.
 To make possible the care of airway, breathing and circulation (e.g. turning the unconscious breathing
patient onto the side or turning a collapsed patient onto the back to perform CPR effectively)
 To make possible the control of severe bleeding.

All unconscious persons who are breathing normally must remain on the side. It is reasonable to roll a face-
down unresponsive patient onto the supine (face up) position to assess airway and breathing and initiate
resuscitation. Concern for protecting the neck should not hinder the evaluation process or life saving
procedures.
The trained first aider should stay with the patient and send others to seek assistance. If movement is necessary
and help is available, the most experienced first aider should take charge and explain clearly and simply the
method of movement to assistants, and to the patient if conscious.
When ready to move the patient:
 Avoid bending or twisting the patient’s neck and back: remember, spinal injury can be aggravated by rough
handling.
 Try to have three or more people assist in the support of the head and neck, the chest, the pelvis and limbs.
 A single first aider may need to drag the patient (either an ankle drag or arm – shoulder drag is acceptable)
 Make prompt arrangements for transport by ambulance to hospital.
The need for oxygen therapy is explained, the administration is demonstrated and the dangers of open
oxygen elaborated.
What Is Oxygen Therapy?
Oxygen therapy is a treatment that provides you with extra oxygen, a gas that your body needs to work well.
Normally, your lungs absorb oxygen from the air. However, some diseases and conditions can prevent you
from getting enough oxygen.
Oxygen therapy may help you function better and be more active. Oxygen is supplied in a metal cylinder or
other container. It flows through a tube and is delivered to your lungs in one of the following ways:
 Through a nasal cannula, which consists of two small plastic tubes, or prongs, that are placed in both
nostrils?
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 Through a face mask, which fits over your nose and mouth?
 Through a small tube inserted into your windpipe through the front of your neck. Your doctor will use a
needle or small incision (cut) to place the tube. Oxygen delivered this way is called transtracheal oxygen
therapy.
Oxygen therapy can be done in a hospital, another medical setting, or at home. If you need oxygen therapy for a
chronic (ongoing) disease or condition, you might receive home oxygen therapy.

Oxygen therapy helps many people function better and be more active. It also may help:
 Decrease shortness of breath and fatigue (tiredness)
 Improve sleep in some people who have sleep-related breathing disorders
 Increase the lifespan of some people who have COPD
Although you may need oxygen therapy long term, it doesn't have to limit your daily routine. Portable oxygen
units can make it easier for you to move around and do many daily activities. Talk with your doctor if you have
questions about whether certain activities are safe for you.
A home equipment provider will work with you to make sure you have the supplies and equipment you need.
Trained staff also will show you how to use the equipment correctly and safely.
Oxygen therapy generally is safe, but it can pose a fire hazard. To use your oxygen safely, follow the
instructions you receive from your home equipment provider.
What is oxygen?
Air is a mixture of gases. Oxygen and nitrogen are the two main gases in the air we breathe. Oxygen accounts
for about 21% of gas in air. The abbreviation for oxygen is O 2. Every cell in our body needs oxygen to live. In
order for oxygen to get to these cells, it must be transported through the airways of the lungs. If there is a
blockage in the airways from mucus or narrowing of the airways from swelling or constriction, air may not
reach enough alveoli to deliver oxygen. In some COPD patients, adequate air is brought into the alveoli, but the
oxygen contained in the air is not able to pass into the capillaries surrounding the alveoli. This results in low
oxygen levels and is called hypoxemia. By breathing even small amounts of additional oxygen, the oxygen
level in the air rises above 21% to 23 or 24%. This small amount is enough to help "push" the oxygen into the
capillaries. Since the body cannot store oxygen, oxygen needs to be given whenever the body is low on oxygen.
In some instances, this means that the COPD patient must use oxygen 24 hours a day. The need for continuous
oxygen is called long term oxygen therapy (LTOT). Oxygen therapy is important to understand because oxygen
is not useful for everyone with COPD. In fact, oxygen is probably one of the least understood and misused
therapies for people with COPD.

How do I know I need oxygen?

The need for oxygen is found by measuring the amount of oxygen in your blood stream. If your oxygen level is
below a critical level at rest, then you need oxygen close to 24 hours a day. Some people with COPD do not
need oxygen when they are inactive, such as when sitting, but need oxygen when exercising, such as walking,
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or with eating and/or sleeping. Breathlessness is not a reliable way of determining if you need oxygen.
Sometimes, you can be very short of breath and not need oxygen; other times your breathing may feel okay, but
you are not getting enough oxygen. Oxygen is not given to treat breathlessness. Although some patients feel
some relief in their breathlessness from the flow of oxygen on their face, less expensive ways of getting this
same relief can be obtained with a fan.
Your healthcare provider will find out if you need oxygen therapy by taking a blood sample from your artery.
This test is called an arterial blood gas (ABG) and it measures carbon dioxide and pH in addition to oxygen.
This can be done in the office, clinic or hospital, wherever the arterial blood equipment is available. When
making an important decision, such as who needs oxygen, the best evaluation is with an ABG. Measuring
oxygen levels can also be done with a pulse oximeter. Oximetry is performed by attaching a clip to your finger
that shines a light through it. A tiny computer in the oximeter then determines your oxygen level by the color of
the light that shines through from the other side. Oximetry only measures one characteristic of the oxygen in
your body and, since it is not as precise as an ABG, should only be used as a guide to oxygen therapy.
How much oxygen should I take?
Oxygen is a medication prescribed by your healthcare provider. Optimally, the amount is carefully decided
based on an ABG and then guided by oximetry. Once the amount of oxygen you need is decided, your provider
will advise you of the rate at which the oxygen should be set. It is very important that you only use the amount
that your doctor or nurse has prescribed, no more or no less. The treatment goal is to keep your oxygen at a
level that meets your body’s need for oxygen, usually above 89%. Taking too much oxygen sends a message to
your brain to slow your breathing. Whereas too little may deprive the tissue in your brain and heart of oxygen
and result in memory loss or changes in your heart.
Pulse sites and pulse monitoring

The pulse, or heart rate, is taken to assist with the assessment of a patient’s cardiovascular function.
Pulse can be felt by placing fingers over any artery lying close to the skin surface. The site most commonly
used is the wrist (radial or lunar arteries) because it is non-invasive and easily accessible but other artery sites
can be used.
Even in small facilities and remote locations there is no need to sacrifice constant monitoring of your critical
points. Pulse monitoring gives you real-time data, alarming, reporting, and access from anywhere. Scalable and
flexible – Pulse is designed for monitoring of facilities of all types and sizes. Stop reacting to problems and
start preventing them.

Pulse provides real-time data readings, alarming, and reporting through an intuitive user interface that puts you
comfortably in the driver’s seat of your facility’s data. From room and freezer temperatures to differential
pressure and humidity, customizable reports and alarm limits ensure your facility is always on track.

A pulse can be felt at locations where large arteries are close to the surface of the body. It is helpful to know
where the major pulses can be detected because monitoring the pulse is important clinically. The heart rate,

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rhythmicity, and other characteristics can be determined by feeling the pulse. A pulse can be felt at three major
locations on each side of the head and neck. One site is the common carotid artery at the point where it divides
into internal and external carotid arteries. A second is the superficial temporal artery immediately anterior to
three ears. A third is in the facial artery at the point where it crosses the inferior border of the mandible
approximately midway between the angle and the genu.

A pulse can be felt at three major points in the upper limb: in the axilla, in the brachial artery on the medial side
of the arm slightly proximal to the elbow, and in the radial artery on the lateral side of the anterior forearm just
proximal to the wrist. The radial artery is by tradition the most common site for detecting the pulse of a patient
because it is the most easily accessible pulse in the body.

A pulse may be felt easily at the femoral artery in the groin, the proximal artery just proximal to the knee, and
the dorsal is pedis artery and the posterior tibial artery at the ankle.

SESSION 6.
Explain and manage shock.

Learning Outcomes
 Demonstrate the management of a specified type of shock according to the symptoms presented.
 Different types of shock are identified and explained according to the specific type.

Explain and manage shock.

Shock is the cause of death in most patients. Early interventions and proper management can save lives.

Shock is a term used to describe the result of the loss of an effective circulation. What this means is that the
circulatory system (heart, lungs and blood vessels) are unable to circulate a sufficient supply of oxygenated
blood to the cells of the body. This leads to the inability of the cells and tissue to function correctly. If
untreated, shock can result in death. This is not to be confused with emotional distress/surprise which is not life
threatening. The three main causes of shock (3) main categories:

 Absolute fluid loss.

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 Relative fluid loss.
 Cardiac failure.
Absolute Fluid Loss – low blood volume (Hypovolemia)
Absolute fluid loss can result from either internal or external bleeding where there is damage to the circulatory
system or loss of body fluids through severe burns, severe vomiting, or severe diarrhoea, etc. This can lead to
an inadequate supply of oxygenated blood to the cells and tissue. The onset of shock starts to occur when a
casualty loses approximately 15% (approximately 750mi for an adult) of the circulating blood volume.
Relative Fluid Loss
Relative fluid loss occurs when there is an abnormal increase in the size of the circulatory system (arteries,
veins and capillaries) within the casualty's body.
This can be due to:
 Severe allergic reaction (anaphylaxis).
 Chemicals or drugs.
 Severe infections.
 Nervous responses.
 Severe brain/spinal cord injury.
The volume of blood stays the same but the size of the circulatory system actually increases (arteries, veins and
capillaries dilate). The effect of this increase in size can be a dramatic drop in blood pressure which can be life
threatening.

Cardiac Failure (Cardiogenic Shock)

Cardiac failure occurs when the heart is suffering from either injury or disease and is unable to pump
effectively or efficiently. The heart has its own blood supply coming from the coronary arteries. If this blood
supply is interrupted by blockages or narrowing, as occurs in a heart attack, the heart will not be able to
function correctly. The result is a lack of oxygenated blood to the cells and tissue.

The Body's Compensation Mechanism

When the supply of oxygenated blood to the cells and tissue is insufficient for the body to function correctly,
the body automatically tries to compensate (homeostasis). Both the breathing rate (respirations) and the heart
rate increase in an attempt to supply oxygenated blood to the cells and tissue. Blood vessels around the skin and
muscles will constrict, directing the blood away from the body's extremities. This allows more of the
oxygenated blood to be directed to the vital organs such as the heart, lungs, brain etc. By the body attempting to
compensate in this manner, it is effectively reducing the size of the circulatory system to maintain the body's
blood pressure and provide oxygenated blood to vital organs.

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The body can only compensate, by how much the heart's ability responds to increased demand. When the body
is unable to compensate any further, the cells, tissue and vital organs (heart, lungs and brain) will be unable to
function efficiently or effectively. If the cause of shock in the casualty is not rectified the vital organs will cease
to function causing death.

Signs and Symptoms of Shock

The casualty's condition will depend on the severity of the underlying cause and may include.

 Increased breathing rate and depth.

 Increased heart rate with a weak pulse.
 Pale, cold and sweaty skin (caused by the blood vessels constricting).
 Weakness and/or dizziness.
 Nausea and vomiting.
 Confusion leading to unconsciousness.
 Slowing of the heart rate and respiration's as the condition deteriorates, leading to death.
Treatment of Shock
As a first aider, you can reduce some of the factors that lead to the shock process by:
 Conducting DRS ABCD (primary survey).
 Controlling bleeding.
 Conducting a secondary survey
Head to Toe
 Laying the casualty down flat.
 Elevating the casualty's legs unless they are fractured or cardiogenic shock is suspected.
 Treating burns and other wounds.
 Treating fractures.
 Reassuring the casualty.
 Loosening any restrictive clothing.
 Protecting the casualty and keeping them comfortable.
 Monitoring vital signs (respirations, pulse rates and level of consciousness) at regular intervals.
 Calling 000 for an ambulance.
Typical shock management involves support with IV fluids and vasopressors. The goal is to increase the
patient's B/P to an acceptable level. The problem with this strategy is that it is short-sighted and doesn't
correct the underlying problem.
Start by redefining shock as decreased tissue oxygenation. Therefore, the goal of shock assessment and
treatment should be to improve tissue oxygenation rather than maintain the blood pressure.
Maintaining tissue oxygenation is a delicate balance between oxygen supply and demand. Merely putting the
patient on oxygen or maintaining the blood pressure is not enough to maintain tissue oxygenation.

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Tissue oxygen supply is composed of lung oxygenation, hemoglobin level and cardiac output. Tissue oxygen
supply must meet oxygen demand or hypoxia ensues.
Different types of shock
Different types of Shock:

 hypovolaemic
 cardiogenic
 distributive
 obstructive

Hypovolaemic shock
 due to inadequate circulating fluid volume
 causes – divided to haemorrhagic or non-haemorrhagic (major burns;
 gastrointestinal losses: vomiting, fistulas; urinary losses: diabetes,
 diabetes insipidus; evaporative losses with fever, abdominal surgery)
 fluid resuscitation
 colloid or crystalloid (do not use dextrose solution)
 replace blood loss
 review source of bleeding and stop bleeding
Cardiogenic shock
 causes – acute myocardial infarction; myocardial contusions post-trauma; myocarditis; acute valvular
dysfunction; post-cardiopulmonary bypass; cardiomyopathy
 control arrhythmia, reverse myocardial ischaemia, specific treatment for myocarditis, open heart surgery
for valvular repair preload – a trial of fluid may be warranted in diastolic heart failure (observe CVP/ BP
/urine output and oxygenation)
 inotropes – dobutamine indicated to augment myocardial contractility in the presence of normal or slightly
reduced blood pressure
 afterload - vasodilator will cause further hypotension start noradrenaline to maintain perfusion
 consider invasive monitoring – pulmonary artery catheter
 discuss with senior – IABP and revascularization procedure may help
Distributive shock
 causes: septic shock; anaphylaxis; spinal shock; hyperthyroidism; severe liver dysfunction - fluids
 in our unit, the combination of agents usually used is dobutamine and noradrenaline; adrenaline for
anaphylaxis
 treat underlying cause e.g. sepsis
Obstructive shock
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 causes – cardiac tamponade; tension pneumothorax; pulmonary or air embolism
 fluid resuscitation for temporary support
 inotropes for temporary support
 relief of obstruction e.g. pericardiocentesis for tamponade
 chest drain for tension pneumothorax
 thrombolysis, embolectomy

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