Before Giving Care and Checking an Injured or Ill Person
American Red Cross
YOUR ROLE IN THE EMS SYSTEM

The system begins when someone like you recognizes that an emergency exists and decides to take action, such as calling 9-1-1 or the local emergency number for help. Early arrival of emergency personnel increases a person’s chance of surviving a life-threatening emergency. Calling 9-1-1 or the local emergency number is the most important action that you can take.



Step 1: Recognize that an Emergency ExistsUnusual noises- Screaming, moaning, yelling or calls for help
- Breaking glass, crashing metal or screeching tires
- A change in the sound made by machinery or equipment
- Sudden, loud noises, such as the sound of collapsing buildings or falling ladders
- Unusual silence
Unusual sights- A stopped vehicle on the roadside or a car that has run off of the road
- Downed electrical wires
- A person lying motionless
- Spilled medication or empty container
- An overturned pot in the kitchen
- Sparks, smoke or ﬁre
Unusual odors- Odors that are stronger than usual
- Unrecognizable odors
- Inappropriate odors
Unusual appearances or behaviors- Unconsciousness
- Confusion, drowsiness or unusual behavior
- Trouble breathing
- Sudden collapse, slip or fall
- Clutching the chest or throat
- A person doubled over in pain
- Slurred, confused or hesitant speech
- Sweating for no apparent reason
- Uncharacteristic skin color
- Inability to move a body part

Step 2: Decide to Act

[Overcoming Barriers to Action]

The most common factors that keep people from responding are:- Panic or fear of doing something wrong
- Being unsure of the person’s condition and what to do
- Assuming someone else will take action
- Type of injury or illness
- Fear of catching a disease (see the Disease Transmission and Prevention section in this chapter)
- Fear of being sued (see discussion of Good Samaritan laws in this chapter)
- Being unsure of when to call 9-1-1 or the local emergency number

[Good Samaritan Laws]

A reasonable and prudent person would:- Move a person only if the person’s life were in danger.
- Ask a conscious person for permission, also called consent, before giving care.
- Check the person for life-threatening conditions before giving further care.
- Call 9-1-1 or the local emergency number.
- Continue to give care until more highly trained personnel take over.


Step 3: Activate the EMS System

Activating the EMS system by calling 9-1-1 or the local emergency number is the most important step you can take in an emergency. You should not hang up before the call taker does so. Once EMS personnel are on the way, the call taker may stay on the line and continue to talk with you. Many call takers also are trained to give ﬁ rst aid instructions so they can assist you with life-saving techniques until EMS personnel take over.
Step 4: Give Care Until Help Takes Over

In general, you should give the appropriate care to an ill or injured person until:- You see an obvious sign of life, such as breathing.
- Another trained responder or EMS personnel take over.
- You are too exhausted to continue.
- The scene becomes unsafe.


Getting Permission to Give Care

People have a basic right to decide what can and cannot be done to their bodies. They have the legal right to accept or refuse emergency care. Therefore, before giving care to an injured or ill person, you must obtain the person’s permission.- Expressed consent
- Implied consent


DISEASE TRANSMISSION AND PREVENTION

Infectious diseases—those that can spread from one person to another—develop when germs invade the body and cause illness.

How Disease Spreads

The most common germs are bacteria and viruses.- Direct contact
- Indirect contact

Animals, including humans and insects, also can spread some diseases through bites. Contracting a disease from a bite is rare in any situation and uncommon when giving ﬁrst aid care.

Other germs can be more serious, such as the Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeﬁciency Virus (HIV), which causes Acquired Immune Deﬁciency Syndrome (AIDS). Although serious, they are not easily transmitted and are not spread by casual contact, such as shaking hands. The primary way to transmit HBV, HCV or HIV during ﬁrst aid care is through blood-to-blood contact.Preventing Disease Transmission
By following some basic guidelines, you can greatly decrease your risk of getting or transmitting an infectious disease while giving care or cleaning up a blood spill.

[While Giving Care]

To prevent disease transmission when giving care, follow what are known as standard precautions:- Avoid contact with blood and other body ﬂuids or objects that may be soiled with blood and other body ﬂuids.
- Use protective CPR breathing barriers.
- Use barriers, such as disposable gloves, between the person’s blood or body ﬂuids and yourself.
- Before putting on personal protective equipment (PPE), such as disposable gloves, cover any of your own cuts, scrapes or sores with a bandage.
- Do not eat, drink or touch your mouth, nose or eyes when giving care or before you wash your hands after care has been given.
Avoid handling any of your personal items, such as
pens or combs, while giving care or before you wash
your hands.
- Do not touch objects that may be soiled with blood or other body ﬂuids.
- Be prepared by having a ﬁrst aid kit handy and stocked with PPE, such as disposable gloves, CPR breathing barriers, eye protection and other supplies.
- Wash your hands thoroughly with soap and warm running water when you have ﬁ nished giving care, even if you wore disposable gloves. Alcohol-based hand sanitizers allow you to clean your hands when soap and water are not readily available and your hands are not visibly soiled. (Keep alcohol-based hand sanitizers out of reach of children.)
- Tell EMS personnel at the scene or your health care provider if you have come into contact with an injured or ill person’s body ﬂuids.
- If an exposure occurs in a workplace setting, follow your company’s exposure control plan for reporting incidents and follow-up (post-exposure) evaluation.


TAKING ACTION: EMERGENCY ACTION STEPS

1. CHECK the scene and the person.
2. CALL 9-1-1 or the local emergency number.
3. CARE for the person.

Check
Before you can help an injured or ill person, make sure that the scene is safe for you and any bystanders. Look the scene over and try to answer these questions:- Is it safe?
- Is immediate danger involved?
- What happened?
- How many people are involved?
- Is anyone else available to help?
- What is wrong?


Call

As a general rule, call 9-1-1 or the local emergency number if the person has any of the following conditions:- Unconsciousness or an altered level of consciousness (LOC), such as drowsiness or confusion
- Breathing problems (trouble breathing or no breathing)
- Chest pain, discomfort or pressure lasting more than a few minutes that goes away and comes back or that radiates to the shoulder, arm, neck, jaw, stomach or back
- Persistent abdominal pain or pressure
- Severe external bleeding (bleeding that spurts or gushes steadily from a wound)
- Vomiting blood or passing blood
- Severe (critical) burns
- Suspected poisoning
- Seizures
- Stroke (sudden weakness on one side of the face/facial droop, sudden weakness on one side of the body, sudden slurred speech or trouble getting words out or a sudden, severe headache)
- Suspected or obvious injuries to the head, neck or spine
- Painful, swollen, deformed areas (suspected broken bone) or an open fracture

Also call 9-1-1 or the local emergency number immediately for any of these situations:- Fire or explosion
- Downed electrical wires
- Swiftly moving or rapidly rising water
- Presence of poisonous gas
- Serious motor-vehicle collisions
- Injured or ill persons who cannot be moved easily


Deciding to Call First or Care First

If you are ALONE:Call First (call 9-1-1 or the local emergency number before giving care) for:- Any adult or child about 12 years of age or older who is unconscious.
- A child or an infant who you witnessed suddenly collapse.
- An unconscious child or infant known to have heart problems.


Care First (give 2 minutes of care, then call 9-1-1 or the local emergency number) for:- An unconscious child (younger than about 12 years of age) who you did not see collapse.
- Any drowning victim.


Care

After making the 9-1-1 call, immediately go back to the injured or ill person. Check the person for life-threatening conditions and give the necessary care, by following these guidelines:- Do no further harm.
- Monitor the person’s breathing and consciousness.
- Help the person rest in the most comfortable position.
- Keep the person from getting chilled or overheated.
- Reassure the person.
- Give any speciﬁc care as needed.

[Transporting the Person Yourself]

In some cases, you may decide to take the injured or ill person to a medical facility yourself instead of waiting for EMS personnel. NEVER transport a person:- When the trip may aggravate the injury or illness or cause additional injury.
- When the person has or may develop a lifethreatening condition.
- If you are unsure of the nature of the injury or illness.

[Moving an Injured or Ill Person]

Generally, you should not move an injured or ill person while giving care. However, it would be appropriate in the following three situations:1. When you are faced with immediate danger, such as ﬁre, lack of oxygen, risk of explosion or a collapsing structure.
2. When you have to get to another person who may have a more serious problem. In this case, you may have to move a person with minor injuries to reach someone needing immediate care.
3. When it is necessary to give proper care. For example, if someone needed CPR, he or she might have to be moved from a bed because CPR needs
to be performed on a ﬁrm, ﬂat surface. If the surface or space is not adequate to give care, the person should be moved.


Types of Non-Emergency Moves- Walking Assist
- Two-Person Seat Carry


Types of Emergency Moves- Pack-Strap Carry
- Blanket Drag
- Ankle Drag
- Clothes Drag


CHECKING A CONSCIOUS PERSON

If you determine that an injured or ill person is conscious and has no immediate life-threatening conditions, you can begin to check for other conditions that may need care. Checking a conscious person with no immediate life-threatening conditions involves two basic steps:- Interview the person and bystanders.
- Check the person from head to toe.


Conducting Interviews

Ask the person and bystanders these simple questions to learn more about what happened:- What happened?
- Do you feel pain or discomfort anywhere?
- Do you have any allergies?
- Do you have any medical conditions or are you taking any medication?


Checking from Head to Toe- Do not move any areas where there is pain or discomfort, or if you suspect a head, neck or spinal injury.
- Check the person’s head by examining the scalp, face, ears, mouth and nose.
- Look for cuts, bruises, bumps or depressions. Think of how the body usually looks. If you are unsure if a body part or limb looks injured, check it against the opposite limb or the other side of the body.
- Watch for changes in consciousness. Notice if the person is drowsy, confused or is not alert.
- Look for changes in the person’s breathing. A healthy person breathes easily, quietly, regularly and without discomfort or pain. Young children and infants generally breathe faster than adults. Breathing that is not normal includes noisy breathing, such as gasping for air; rasping, gurgling or whistling sounds; breathing that is unusually fast or slow; and breathing that is painful.
- Notice how the skin looks and feels. Skin can provide clues that a person is injured or ill. Feel the person’s forehead with the back of your hand to determine if the skin feels unusually damp, dry, cool or hot. Note if it is red, pale or ashen.
- Look over the body. Ask again about any areas that hurt. Ask the person to move each part of the body that does not hurt. Ask the person to gently move his or her head from side to side. Check the shoulders by asking the person to shrug them. Check the chest and abdomen by asking the person to take a deep breath. Ask the person to move his or her ﬁngers, hands and arms; and then the toes, legs and hips in the same way. Watch the person’s face and listen for signals of discomfort or pain as you check for injuries.
- Look for a medical identiﬁcation (ID) tag, bracelet or necklace on the person’s wrist, neck or ankle. A tag will provide medical information about the person, explain how to care for certain conditions and list whom to call for help. For example, a person with diabetes may have some form of medical ID tag, bracelet or necklace identifying this condition.


SHOCK

Shock is a condition in which the circulatory system fails to deliver enough oxygen-rich blood to the body’s tissues and vital organs. The body’s organs, such as the brain, heart and lungs, do not function properly without this blood supply.

The signals that indicate a person may be going into shock include:- Restlessness or irritability.
- Altered level of consciousness.
- Nausea or vomiting.
- Pale, ashen or grayish, cool, moist skin.
- Rapid breathing and pulse.
- Excessive thirst.

Be aware that the early signals of shock may not be present in young children and infants. However, because children are smaller than adults, they have less blood volume and are more susceptible to shock.

In cases where the person is going into shock, call 9-1-1 or the local emergency number immediately. Shock cannot be managed effectively by ﬁrst aid alone. A person suffering from shock requires emergency medical care as soon as possible.

What to Do Until Help Arrives

Caring for shock involves the following simple steps:- Have the person lie down. This often is the most comfortable position. Helping the person rest in a more comfortable position may lessen any pain. Helping the person to rest comfortably is important because pain can intensify the body’s stress and speed up the progression of shock.
- Control any external bleeding.a. Since you may not be sure of the person’s condition, leave him or her lying ﬂ at.
b. Help the person maintain normal body temperature. If the person is cool, try to cover him or her to avoid chilling.
c. Do not give the person anything to eat or drink, even though he or she is likely to be thirsty. The person’s condition may be severe enough to require surgery, in which case it is better if the stomach is empty.
- Reassure the person.
- Continue to monitor the person’s breathing and for any changes in the person’s condition. Do not wait for signals of shock to develop before caring for the underlying injury or illness.


CHECKING AN UNCONSCIOUS PERSON

If you think someone is unconscious, tap him or her on the shoulder and ask if he or she is OK. Use the person’s name if you know it. Speak loudly. If you are not sure whether an infant is unconscious, check by tapping the infant’s shoulder and shouting or by ﬂicking the bottom of the infant’s foot to see if the infant responds. If the person does not respond, call 9-1-1 or the local emergency number and check for other life-threatening conditions.

Always check to see if an unconscious person:- Has an open airway and is breathing normally.
- Is bleeding severely.


Airway

Once you or someone else has called 9-1-1 or the local emergency number, check to see if the person has an open airway and is breathing. An open airway allows air to enter the lungs for the person to breathe. If the airway is blocked, the person cannot breathe. A blocked airway is a life-threatening condition.- When someone is unconscious and lying on his or her back, the tongue may fall to the back of the throat and block the airway. To open an unconscious person’s airway, push down on his or her forehead while pulling up on the bony part of the chin with two or three ﬁngers of your other hand. This procedure, known as the head-tilt/chin-lift technique, moves the tongue away from the back of the throat, allowing air to enter the lungs.a. For a child: Place one hand on the forehead
and tilt the head slightly past a neutral position (the head and chin are neither ﬂexed downward toward the chest nor extended backward).
b. For an infant: Place one hand on the forehead and tilt the head to a neutral position while pulling up on the bony part of the chin with two or three ﬁngers of your other hand.
- If you suspect that a person has a head, neck or spinal
injury, carefully tilt the head and lift the chin just
enough to open the airway.


Breathing

After opening the airway, quickly check an unconscious person for breathing. Position yourself so that you can look to see if the person’s chest clearly rises and falls, listen for escaping air and feel for it against the side of your face. Do this for no more than 10 seconds. If the person needs CPR, chest compressions must not be delayed.Agonal breathing?

If an adult is not breathing normally, this person most likely needs immediate CPR. If a child or an infant is not breathing, give 2 rescue breaths. If you witness the sudden collapse of a child, assume a cardiac emergency. Do not give 2 rescue breaths. CPR needs to be started immediately, just as with an adult.

Circulation

If an adult is not breathing or is not breathing normally and if the emergency is not the result of non-fatal drowning or other respiratory cause such as a drug overdose, assume that the problem is a cardiac emergency. Quickly look for severe bleeding by looking over the person’s body from head to toe for signals such as blood-soaked clothing or blood spurting out of a wound. Bleeding usually looks worse than it is. A small amount of blood on a slick surface or mixed with water usually looks like a large volume of blood. It is not always easy to recognize severe bleeding.

What to Do Next- If an unconscious person is breathing normally, keep the person lying face-up and maintain an open airway with the head-tilt/chin-lift technique. If the person vomits, ﬂuids block the airway, or if you must leave the person to get help, place him or her into a modiﬁed high arm in endangered spine (H.A.IN.E.S.) recovery position.
- If an unconscious adult has irregular, gasping or shallow breaths (agonal breathing) or is not breathing at all, begin CPR.
- If an unconscious child or infant is not breathing, after giving 2 rescue breaths, perform CPR.
- If the person is bleeding severely, control the bleeding by applying direct pressure.


Special Situations- Air in the Stomach: When you are giving rescue breaths, be careful to avoid forcing air into the person’s stomach instead of the lungs. This may happen if you breathe too long, breathe too hard or do not open the airway far enough.
- Vomiting. Even when you are giving rescue breaths properly, the person may vomit.
- Mouth-to-Nose Breathing. If you are unable to make a tight enough seal over the person’s mouth, you can blow into the nose.
- Mouth-to-Stoma Breathing. Check the person’s neck to see if he or she breathes through a stoma.
- Head, Neck and Spinal Injuries. Be especially careful with a person who may have a head, neck or spinal injury.
- Drowning Victims. For an adult, give 2 rescue breaths as you would for a child or an infant once you determine there is no breathing. If alone, you should give 2 minutes of care before calling 9-1-1 for an unconscious person who has been submerged. Do not enter the water unless you are speciﬁcally trained to perform in-water rescues.


Placing an Unconscious Person in a Recovery Position- Kneel at the person’s side.
- Reach across the body and lift the arm farthest from you up next to the head with the person’s palm facing up.
- Take the person’s arm closest to you and place it next to his or her side.
- Grasp the leg farthest from you and bend it up.
- Using your hand that is closest to the person’s head, cup the base of the skull in the palm of your hand and carefully slide your forearm under the person’s shoulder closest to you. Do not lift or push the head or neck.
- Place your other hand under the arm and hip closest to you.
- Using a smooth motion, roll the person away from you by lifting with your hand and forearm. Make sure the person’s head remains in contact with the extended arm and be sure to support the head and neck with your hand.
- Stop all movement when the person is on his or her side.
- Bend the knee closest to you and place it on top of the other knee so that both knees are in a bent position.
- Make sure the arm on top is in line with the upper body.
- If you must leave the person to get help, place the hand of the upper arm palm side down with the ﬁngers under the head at the armpit of the extended lower arm.
Write the lyrics for a misc song made in 2013, titled "Before Giving Care and Checking an Injured or Ill Person", by artist "American Red Cross".