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Transcript
In Flight Emergencies • • • • • • • • CPR – AED Chain of Command First Aid Review OSHA Bloodborne Pathogens Hazardous Materials Emergency Procedures Communicable Disease Next Slide Chain of Survival Notify Capt. Access AED Early CPR Early Early Defibrillation Advanced Care Notify Pilot Early Recognition Initial Life Support ABCS CARE The Plan CPR and Med Kit Timely Definitive Care Continued Life Support ABCS CARE Rapid Defibrillation Extent of the Problem • 1.1 million heart attacks Annually • 480,000 deaths due to coronary heart disease • 250,000 prehospital cardiac arrests annually • Landing time to closest airport • Other problems • Lack of Training • Unfamiliar with CPR or AED Recognize Emergency • Airway obstruction – Universal distress signal, blue skin Perform Abdominal Thrusts • Respiratory arrest – Not breathing - Agonal Breaths • Cardiac arrest – Not breathing and no signs of life or pulse present – Blue is Bad – Start CPR – Open Airway – Give 2 breaths – Check for signs of life Open Airway • Head Tilt/Chin Lift • Empty the mouth? Check Breathing • Look • Listen • Feel Breathing A - Quantity - Quality – Open Airway Tilt Head back Lift Chin up B – Check Breathing No Breathing Use mask or Shield Give 2 easy Breaths that make chest rise Signs of Cardiac Arrest • Unresponsive • Not breathing • No signs of circulation or pulse • START Chest Compressions • 30:2 – 5 Cycles • Press Hard • Press Fast 100/Min 2 inches Begin CPR – 5 cycles 2 Breaths 30 Compressions AEDs and Ventricular Fibrillation • VF is the most frequent initial rhythm in sudden cardiac arrest • VF is a useless quivering of the heart that results in no blood flow • Defibrillation is the only effective treatment for VF • Successful electrical defibrillation diminishes rapidly over time Time and AEDs • Approximately 50% survival after 5 minutes • Survival reduced by 7% to 10% each minute • Rapid defibrillation is 100 key 80 • CPR helps extend survival 60 time 40 Survival 20 0 1 3 6 10 minutes Heartsaver AED for the Lay Rescuer and First Responder A – Airway B – Breathing C – Circulation D – Defibrillation Special Considerations • Is victim lying in water? • Is victim less than 8 years old? • Is victim wearing a transdermal medication patch on his or her chest? • Does victim have a pacemaker or implanted defibrillator? Cardiac Pacemakers • Small device implanted under the skin (commonly inferior to either clavicle). – Device provides electrical stimuli for the heart should the internal pacemaker site fail to operate properly. – You can easily see and palpate this device when your patient has had one surgically placed. – You can still use the AED; just do not apply an electrode directly over the pacemaker site. Precautions & Concerns Avoid Placing the Electrode Directly Over Implanted Heart Devices R Pacemaker AEDs and Personnel • One rescuer – – – – Unresponsiveness Notify - Get the AED Position Patient - Assess Breathing / Signs of Life / Pulse Attach and use AED • Two rescuers – #1 – Notify /Perform CPR – #2 – Attach and use AED • More than two rescuers – – – – #1 – Notify #2 – Evaluate and use AED #3 – Perform CPR #4 – Med Kit / Med Com Operation of AED • • • • • • POWER ON the AED ATTACH pads ANALYZE rhythm SHOCK (if advised) Witnessed – Use AED Un-witnessed – Perform 2 Minutes CPR then use AED Electrode Pad Placement • Right electrode pad – To the right of the breastbone – Below the collarbone above the right nipple • Left electrode pad – Outside the left nipple, upper edge of the pad several inches below the left armpit Effective Adherence of Pads • Sweaty chest – Dry with a towel – Do not use alcohol • Hairy chest – Shaving may be needed AED Safety • No patient contact during analysis and shock • Warn bystanders: – “I’m clear” – “You’re clear” – “Everybody’s clear” • Perform a visual inspection • Press to shock AED Summary • Use AED as indicated • Perform CPR as needed • Do Not remove AED until EMS arrival. • Complete incident report • Re-stock AED • Critique incident • Review guidelines First Aid Quick Review CPR Stroke Bleeding AED Heart Attack Seizures Head Injuries Burns Allergic Reaction Choking Fractures Shock Diabetes Choking • Adult – perform up to 5 abdominal thrusts.repeat if necessaryunable to reach around abdoman – perform a chest thrust Unconscious – check mouth and perform steps of CPR. • Child – perform up to 5 abdominal thrusts kneeling behind. Repeat if necessary – Unconscious – perform steps of CPR – do not perform blind finger sweeps. • Infant – perform 5 back slaps / 5 chest thrusts – Unconscious – perform steps of CPR – do not perform blind finger sweeps The steps of CPR • • • • • • • • Establish Unresponsiveness Open Airway – Give 2 Breaths Check for signs of Life – If Absent Start Chest Compressions / Breaths Perform 5 Cycles – Press Hard – Press Fast – 100 / Min Adult – 30:2 – 2 Hands – center of chest between nipples Child – 30:2 – 1 or 2 Hands - depending on size. Infant – 30:2 – 2 Fingers - between nipples • Pediatric compression depth is ½ to 1/3 the depth of their chest Automatic External Defibrillator Turn on AED • Remove all clothing from patients chest including bra. • Attach AED Pads • Follow Icons / Voice Prompts • Clear to Analyze • Clear to Shock • Follow Directions • Do Not Disconnect AED • Turn over Patient to EMS • Restock AED • Review Incident Special Considerations • Pediatric size AED pads • Implantable device • Transdermal Med Patch • Hairy Chest • AED use in wet conditions • AED battery life • AED self testing • AED Laws • Local EMS Decreased Level Of Consciousness • Evaluate Level Of Consciousness • • • • • • • • • • Abnormally Sleepy Alcohol Drugs Stroke Diabetes –glucometer Blood sugar 90-120 Low < 80 w symptoms Give sugar High > 200 Contact medical direction Difficulty Breathing • Asthma – Inhaler • Anxiety – Psychological FA • Allergic – Use Epi pen • Call MD - Benedryl • Call EMS – breathing treatment • Fluid in Lungs – sound = rales Sign of Congestive Heart Failure - Blue is Bad • Chronic Obstructed Pulmonary Disease / Emphysemia • Pink Puffers – Next Slide Conditions that Cause Breathing Difficulty Obstructive Lung Disease: Emphysema Findings • Thin, barrel chest appearance • Generally unproductive cough • Prolonged exhalation through pursed lips • Diminished breath sounds • Possible wheezing or ronchi • Dyspnea on exertion • Pink completion (pink puffers) • Tachypneic and tachycardic • Tripod positioning, and commonly on oxygen at home Sudden Difficulty Breathing – Pulmonary Embolism • Sudden Onset • Common findings • Caused by long periods of inactivity • Blood clotting Thermal Burns • • • • First & Second Apply cool water to burn area Third Use burn sheet Treat for Shock Contact Medical Direction Bleeding • Artery – Direct Pressure • Vein – Apply dressing • Capillary – Band Aid • Use Sterile dressing • Use Sterile bandage • Change daily • Keep it dry • AAA Ointment • Tetanus • Infection Wound Care • Direct pressure • Pressure bandage SHOCK • • • • Check ABC’s Check for and Treat Injuries Elevate Legs Stop if there is pain upon movement • Cover with blanket • Conserve Body heat • Nothing to eat or drink • Signs – pale – sweaty • Symptoms – nausea - dizzy Fractures • Splint arm or leg with pillow blanket or splint • Do not wrap to tight • Check circulation • Leave fingers and toes exposed • Apply Ice – not directly on skin • Maintain position of comfort • Do not move if angulated • Treat for Shock • Seek Medical direction Stroke – Seizure – Head Injuries • Stroke – Head ache, facial droop,slurred speech,loss of movement Contact medical direction to locate the closest stroke center hospital • Seizure – Protect passenger from further injury – determine if traumatic, epilepsy or febrile in nature. • Head Injury – Put on PPE -treat bleeding -maintain in line immobilization – log roll if turning on side is necessary to clear airway. Use jaw thrust to open airway if victim unable to maintain airway. Hazardous Materials • • • • • • • Who, Why,When,Where,What is it ? Proper storage & handling Value Jet Crash – Haz-mat cargo fire UPS – cargo fire - they walked away Immediately report unusual cargo Report suspicious activity Airliners.Net – slide deployment Hazardous Materials - Routes of Exposure • Skin Contact – Ingestion – Inhalation - Injection • Types of Physical Hazards Combustible – Compressed gas – Explosive – Flammable Organic peroxide – Oxidizer - Reactive • Types of Health Hazards Toxic – Carcinogen - Corrosive – Irritants Hazardous Materials • • • • Proper Handling - Labeling - Storage Air Bill - Identification – Is it approved? Material Safety Data Sheet Ingredients – Physical data - Life Safety – Fire – Explosion Health Hazard data – Reactivity – Spill & Leak Procedures Special Protection ( gloves,eyes,respiratory,ventilation) Special Precautions( grounding,storage,no smoking or eating) • Emergency Evacuation EMERGENCY PROCEDURES • • • • • • 737 Exits Evacuation Techniques Floatation Device Ditching: Survival on Water LOST is BS Ups & Downs of Cabin Pressurization Exit Drills • • • • Exit Doors Exit Drills Emergency slide Disarming PRINCIPLES OF DISEASES TRANSMISSION . TERMINOLOGY AND CONCEPTS • Bacteria - type of living microorganism that can produce disease in a suitable host, can multiply outside of the cells on surfaces or objects • Virus - type of microorganism normally resides within other living cells and cannot multiply outside living cells TERMINOLOGY AND CONCEPTS • Infection - growth of an organism in a suitable host with or without detectable signs of illness • Infection Control - efforts designed to protect both the patient and care provider • Infectious Disease - any illness resulting from invasion of a host by diseaseproducing organisms such as bacteria, viruses, fungi or parasites TERMINOLOGY AND CONCEPTS • Communicable Disease - a disease which can be readily passed from person to person • Bloodborne Disease - disease spread by contact with blood or other bodily fluids • Airborne Disease -disease spread by droplets of an organism expelled into the air by productive cough or sneeze TERMINOLOGY AND CONCEPTS • Foodborne Disease - disease spread through improperly prepared, uncovered or improperly refrigerated foods • Antigen - a substance that the body recognizes as foreign including pathogens • Antibodies - product created by the immune system to fight invading antigens TERMINOLOGY AND CONCEPTS Cont. • Seroconversion - a change in the status of serum testing • Window Phase - time from exposure to the disease to positive testing • Incubation Phase - the period of time beginning with exposure to the disease until the first appearance of symptoms TWO METHODS OF DISEASE TRANSMISSION • Direct Transmission - occurs when the disease passes directly from one person to another because of contact with infected blood/other body fluids or airborne route • Indirect Transmission - occurs without direct person-to-person contact, such as through a contaminated object BODY FLUIDS WHICH POSE AN INFECTIOUS RISK • • • • • • Blood Cerebral Spinal Fluid Synovial Fluid Pericardial Fluid Amniotic Fluid Any fluids containing blood BODY FLUIDS WHICH DO NOT POSE A RISK • • • • • • • Sweat Tears Saliva Urine Feces Vomitus Nasal Secretions NOTE: Hepatitis A which is not bloodborne can be transmitted via feces COMMON BLOOD/BODILY FLUID BORNE DISEASES HIV/AIDS -VIRUS Hepatitis B -VIRUS Hepatitis C - VIRUS Syphilis - BACTERIA PERSONAL PROTECTIVE MEASURES COMMON TUBERCULOSIS MENINGITIS MUMPS MEASLES RUBELLA CHICKEN POX AIRBORNE DISEASES TUBERCULOSIS TUBERCULOSIS / HIV SIGNS & SYMPTOMS • • • • • • • Fever Night sweats Weight loss Fatigue HIV – Purple skin sores TB Cough TB-Hemoptysis - coughing up blood TUBERCULOSIS PERSONAL PROTECTION MEASURES • HEPA type masks for prehospital care providers – Ability to filter particles 1 micron in size, with a filter efficiency of equal to or greater than 95% given flow rates of up to 50 liters per minute – N95 mask – Ability to be qualitatively/quantitatively fit tested in a reliable way to obtain a face-seal leakage of equal to or less than 10% – Ability to fit different facial sizes & characteristics of healthcare workers – Ability to check face piece fit, in accordance with standards established by OSHA and good industrial hygiene practice by health care workers each time they put on their masks PREVENTION OF INFECTIOUS DISEASE Interrupt the disease process by dealing with any one of it’s four components, remove it from the cycle and the process can be stopped Prevention by Interruption of the Disease Process Infectious Agent Virulence & Dose Direct & Indirect Means of Transmission Host Resistance Protective Measures Routes of Exposure Airborne Bloodborne Foodborne Exposure Reporting Stop – Wash - Report • Report all exposures to your Employer – Stop what you are doing – Wash the area with soap and water – Report the exposure – Complete paperwork • Protect yourself • Apply a surgical mask to patient during transport if it will not interfere with treatment or worsen medical condition – Assuming pt condition does not contraindicate use of mask UNIVERSAL PRECAUTIONS • Infectious control strategy developed by the Center for Disease Control which was originally designed for controlled health care settings – Blood and specific bodily fluids of all patients are considered to have potential infectious pathogens for human immunodeficiency virus (HIV), Hepatitis B virus (HBV) and other bloodborne diseases BODY SUBSTANCE ISOLATION (BSI) • PreHospital strategy for infection control – All body substances have potential infectious pathogens If it’s wet and it’s not yours it’s dangerous TUBERCULOSIS PERSONAL PROTECTION MEASURES •HEPA type masks for pre-hospital care providers –Ability to filter particles 1 micron in size, with a filter efficiency of equal to or greater than 95% given flow rates of up to 50 liters per minute – N95 mask –Ability to be qualitatively/quantitatively fit tested in a reliable way to obtain a face-seal leakage of equal to or less than 10% –Ability to fit different facial sizes & characteristics of healthcare workers –Ability to check face piece fit, in accordance with standards established by OSHA and good industrial hygiene practice by health care workers each time they put on their masks Exposure Reporting Stop – Wash - Report •Report all exposures to your Employer –Stop what you are doing –Wash the area with soap and water –Report the exposure –Complete paperwork •Protect yourself - Use N95 mask •Apply a surgical mask to patient during transport if it will not interfere with treatment or worsen medical condition •Assuming pt condition does not contraindicate use of mask PERSONAL PROTECTIVE EQUIPMENT Barrier Protection - used to isolate mucous membranes and skin from contact with blood or other potentially infectious materials PERSONAL PROTECTIVE EQUIPMENT •GLOVES –MEDICAL EXAM •Latex more tear resistant •Latex sensitivity (rash) can occur with misuse •Vinyl good for simple exams •Latex & vinyl not appropriate for cleaning –HEAVY DUTY LATEX gloves should be used for cleaning –LEATHER GLOVES - should be disposed of if contaminated with blood - cleaning near impossible National Institute of Occupational Safety and Health (NIOSH) June 1997 notice regarding latex glove sensitivity/allergy. Less than 0.8% of population have latex allergy ENGINEERING/WORK PRACTICE CONTROLS SHARPS CONTAINERS •Puncture and leak proof •Required markings •Single use versus multiple use containers –Selection should be based on what works best from a situation and personal perspective •Only sharps should be put in containers –Cost of containers disposal is generally by weight •Storage and disposal –Must meet all OSHA guidelines CONTAMINATED MATERIALS •Red Bags –Required markings –What does/does not go in red bags •Non-sharps – •Blood/body fluid contaminated disposables i.e.. 4x4’s, kling –Bag sealing - use proper technique to assure contamination does not occur –Storage and disposal •Must meet all OSHA guidelines •EMS will dispose of red bags HANDWASHING •Areas for hand washing are to be readily accessible to employees •When hand washing areas are not feasible, alternative systems for hand washing shall be available –Treated Towelettes –Water-less hand washing foam/jells It’s Never the End so Be Safe and Look Good Doing It..! • Thank You for visiting the Emergency Medical Equipment and First Aid Review. • Click on our logo to go back to:
