Professional Documents
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The package you have in hand contains the information you need to teach effective and
fun first aid and CPR courses through Emergency First Response (EFR). We’re glad you
picked EFR as your First Aid/CPR organization, and we are looking forward to building a
successful partnership with you.
You can begin your instructor course today by starting the independent learning segment
of your program. In the Appendix of this guide, go to page A-36 - Independent Learning,
Self-Study Instructor Knowledge Reviews. This material and knowledge reviews will help you
become familiar with the enclosed guides and the material you need to begin teaching EFR
courses. Complete the reviews in any order you like:
¨ Simply look through the two enclosed instructor guides (Emergency First Response –
Primary and Secondary Care; and EFR Care for Children) and answer the questions in
the corresponding self-study knowledge reviews.
¨ Read the Human Body Systems section found in the Appendix of the EFR Instructor
Guide, and complete the corresponding self-study knowledge review.
¨ Read the Medical Emergencies section found in the Emergency First Response Primary
Care and Secondary Care Participant Manual and complete the corresponding self-study
knowledge review.
If you haven’t already, contact an Emergency First Response Instructor Trainer to begin
your practical training at your convenience. For assistance in locating a trainer near you,
contact your Emergency First Response Regional Headquarters.
We are your emergency care organization. EFR is here to help you, the instructor, inspire
confidence in others to offer help to those in need. Through the powerful combination of
your skills and our materials and support, we are “Creating Confidence to Care” in those
we teach.
Welcome! And don’t hesitate to call on us if we can assist you in any way.
Sincerely,
Drew Richardson
President
Emergency First Response, Corp.
Section One – Course Overview and Standards
EMERGENCY
FIRST
RESPONSE ®
Instructor Guide
Primary and
Secondary
Care
emergencyfirstresponse.com
Product No. 67040 (07/11) Version 1.0 © Emergency First Response Corp. 2011
i
Primary and Secondary Care Instructor Guide
www.emergencyfirstresponse.com
Emergency First Response Corp.
30151 Tomas, Rancho Santa Margarita, CA 92688
Toll Free US and Canada: 800 337 1864
Tel: +1 949 766 4261, Fax: +1 949 858 8211
info@emergencyfirstresponse.com
Emergency First Response EMEA Ltd
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Tel: +44 (0) 117 300 7238 Fax: +44 (0) 117 300 7271
info@emergencyfirstresponse.co.uk
Oberwilerstrasse 3, CH-8442 Hettlingen
Tel: +41 52 316 35 35 Fax: +41 52 304 14 98
info@emergencyfirstresponse.ch
Emergency First Response (Asia Pacific) Pty Ltd.
Unit 3, 4 Skyline Place, Frenchs Forest NSW 2086, Australia
Tel: +61 2 9454 2980, Fax: +61 2 9454 2999
info@emergencyfirstresponse.com.au
Emergency First Response® (EFR®) Primary and Secondary Care Instructor Guide
© Emergency First Response Corp. 2011.
Produced by Emergency First Response Corp.
Items in the Appendix may be reproduced by EFR Instructors for use in EFR-sanctioned training, but not for resale
or personal gain. No other part of this product may be reproduced, sold or distributed in any form without the written
permission of the publisher.
® indicates a trademark is registered in the U.S. and certain other countries.
Published by Emergency First Response Corp.
30151 Tomas, Rancho Santa Margarita, CA 92688 USA
Printed in U.S.A.
Product No. 67040 (07/11) Version 1.0
ii
Acknowledgements
Patient Care Standards
Emergency First Response Primary Care (CPR) and Secondary Care (First Aid) courses follow the
emergency considerations and protocols as developed by the members of the International Liaison
Committee on Resuscitation (ILCOR). Members include American Heart Association (AHA), European
Resuscitation Council (ERC), Australian Resuscitation Council (ARC), New Zealand Resuscitation
Council (NZRC), Heart and Stroke Foundation of Canada (HSFC), Resuscitation Council of Southern
Africa (RCSA), Inter American Heart Foundation (IAHF), Resuscitation Council of Asia (RCA – current
members include Japan, Korea, Singapore, Taiwan).
Source authority for the development of content material in Emergency First Response programs is based on
the following:
• Circulation, Journal of the American Heart Association. Volume 122, Number 18, Supplement 3.
November 2010. http://circ.ahajournals.org/content/vol122/18_suppl_3/
• Resuscitation, Journal of the European Resuscitation Council. Volume 81, Number 1. October 2010.
http://www.resuscitationjournal.com/
• Australian Resuscitation Council Guidelines. December 2010.
http://www.resus.org.au/policy/guidelines/index.asp.
• New Zealand Resuscitation Council Policies and Guidelines. December 2010.
http://www.nzrc.org.nz/policies-and-guidelines/.
When regional primary or secondary care guidelines differ significantly, the Emergency First Response
curriculum clearly lists those differences. When in doubt about a particular treatment protocol or procedure,
always refer to the actual guidelines produced by the council or organization having authority in your region.
Disclaimer: The first aid and CPR procedures presented in Emergency First Response programs are based on the most current
recommendations of responsible medical sources. Emergency First Response, Corp., however, can make no guarantee as to, and assume
no responsibility for, the correctness, sufficiency, or completeness of such information or recommendations. Other or additional safety
measures may be required under particular circumstances.
iii
Primary and Secondary Care Instructor Guide
Contents
Introduction
How to Use This Instructor Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
iv
Section Three - Skill Development
Skill Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
Practice Groups – Why And How . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2
The Ability to Replicate Skills Without Hesitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2
Positive Coaching – Encouraging Good Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
Teaching the Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4
Skill Development – Primary Care (CPR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6
Skill 1 – Scene Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6
Skill 2 – Barrier Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10
Skill 3 – Primary Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12
Skill 4 – CPR: Chest Compressions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-17
Skill 5 – CPR: Chest Compressions With Rescue Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-20
Optional Primary Skill – Automated External Defibrillator (AED) Use. . . . . . . . . . . . . . . . . . . 3-25
Skill 6 – Serious Bleeding Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28
Skill 7 – Shock Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-30
Skill 8 – Spinal Injury Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-32
Skill 9 – Conscious And Unconscious Choking Adult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-34
Optional Primary Skill – Emergency Oxygen Use Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . 3-39
Skill Development – Secondary Care (First Aid) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-41
Skill 1 – Injury Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-42
Skill 2 – Illness Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-45
Skill 3 – Bandaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-49
Skill 4 – Splinting for Dislocations and Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-52
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1
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Primary and Secondary Care Instructor Guide
vi
Introduction
The Emergency First Response® Primary Care (CPR), Secondary Care (First Aid), CPR &
AED and Care for Children courses teach people how to provide emergency care for someone
in need. These four courses make learning easy by providing a non stressful environment in
which participants practice and apply emergency care skills. The courses are designed to: 1) help
participants remember appropriate emergency care procedures during times of need, and 2)
encourage them to apply those procedures by assisting those needing emergency care.
Emergency First Response courses are based on
internationally recognized medical guidelines for emergency
care – guidelines produced through a consensus process
of practicing professionals in the emergency medical
field. Educationally, the courses reflect a well-researched
instructional design for this type of training.
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Primary and Secondary Care Instructor Guide
Section One
Course Overview and Standards
This section covers general background and information on how to
conduct both of the Emergency First Response courses. Topics include:
• Course Overview and Standards
• Patient Care Standards
• Course Philosophy
• Course Goals
• Core Performance Requirements
• Course Structure
• Instructor Role
• Course Standards
Section Two
Knowledge Development
This section details how to teach the foundational material for both courses. It explains the basis
for effective use of independent study materials, the philosophy behind guiding self-directed
learning and how to determine when participants need knowledge development assistance. Use
the Knowledge Development Outlines in this section if independent study isn’t possible because
participants don’t have access to an Emergency First Response Participant Manual , or Video in a
language they understand.
Section Three
Skill Development
This section outlines the nine required and two optional skills for Primary Care. It also includes
the four required skills for Secondary Care. Instructor notes and skill descriptions provide detailed
guidelines for leading participants through each skill and reinforcing correct techniques.
You’ll find specific directions and suggestions for effective skill development based on how much,
if any, interaction participants have with the Emergency First Response Participant Manual, or Video.
During skill development, you introduce and demonstrate skills, then have participants practice
while you provide encouragement and suggestions.
Typically, skill development encompasses the majority of instructor-participant contact time.
2
Section Four
Scenario Practice
This section covers emergency scenarios that allow participants to apply their Emergency Responder
knowledge and skills to realistic situations. There are four primary care scenarios and one secondary
care scenario. Each scenario outlines situations that require participants to make decisions based
on their training, recall steps for performing emergency care skills and take appropriate action.
Although each scenario focuses on a specific emergency or accident, you may change the location
and other factors to accommodate regional needs and procedures.
Step-by-step procedures for conducting scenarios help you guide practice. Evaluation questions
allow you to discuss participant performance and concerns. By helping participants apply skills and
knowledge through scenarios, you build confidence and reinforce the need to act.
Appendix
The first part of the Appendix includes forms and information you’ll use when preparing for and
teaching Emergency First Response Primary and Secondary Care courses. You can make copies of
these forms for use in your classes.
The second part of the Appendix covers foundational knowledge needed for the Emergency First
Response Instructor Course. The Human Body Systems segment covers how the various systems
in the human body work and how they relate to the Emergency Responder. As an Emergency First
Response instructor candidate, you’ll read this segment and answer the included Knowledge Review
questions. This segment also serves as background reference for you when teaching Emergency First
Response courses.
3
Primary and Secondary Care Instructor Guide
4
Section One – Course Overview and Standards
One
Course Overview and Standards
The two courses, Emergency First Response Primary Care (CPR) and Emergency First Response
Secondary Care (First Aid), make up foundational offerings in emergency care for the lay provider.
Within the two courses, CPR and first aid skills are integrated into an easy-to-remember emergency
care sequence. This sequence allows participants to provide
effective emergency care to injured or ill persons.
Because of the sequence of skills and information,
participants must complete the Emergency First Response
Primary Care (CPR) course (or other qualifying course)
before beginning the Emergency First Response Secondary
Care (First Aid) course. Participant material is the same for
both courses.
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Primary and Secondary Care Instructor Guide
Emergency First Response Primary Care (CPR) and Secondary Care (First Aid) courses follow the
emergency considerations and protocols as developed by the members of the International Liaison
Committee on Resuscitation (ILCOR).
Source authority for the development of content material in Emergency First Response programs is
based on the following:
• Circulation, Journal of the American Heart Association. Volume 122, Number 18,
Supplement 3. November 2010. http://circ.ahajournals.org/content/vol122/18_suppl_3/
• Resuscitation, Journal of the European Resuscitation Council. Volume 81, Number 1.
October 2010. http://www.resuscitationjournal.com/
• Australian Resuscitation Council Guidelines. December 2010.
http://www.resus.org.au/policy/guidelines/index.asp.
• New Zealand Resuscitation Council Policies and Guidelines. December 2010.
http://www.nzrc.org.nz/policies-and-guidelines/.
Course Philosophy
The Emergency First Response Primary Care (CPR) course covers emergency care for most life-
threatening situations. Students are taught the Cycle of Care to guide them.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
The Emergency First Response Secondary Care (First Aid) course covers secondary patient
assessment and first aid. Secondary patient assessment teaches participants how to conduct patient
head-to-toe evaluations, allowing them to determine the extent of an injury or illness when
Emergency Medical Service personnel are unavailable or delayed. Participants learn both injury and
illness assessment sequences, which helps them prepare information for EMS personnel. The first aid
portion of the course teaches participants how to support and care for specific disabilities, injuries
and illnesses discovered during a secondary patient assessment and prior to EMS arrival.
1-2
Section One – Course Overview and Standards
Emergency First Response Primary Care (CPR) and Secondary Care (First Aid) courses adhere to
the following instructional design philosophy and core concepts:
• Course Simplification. Widespread consensus within the medical community and
instructional design research indicate that community-based, layperson CPR training is to
be simple in both course content and scope. Research studies indicate that simpler, objective-
based, media centric courses do a better job at teaching patient care skills for retention than
do longer, more traditional lecture-style courses.
• Performance-Based Instruction. Performance-based instruction means participants
progress through a course at their own speed by meeting measurable learning objectives and
performance requirements. The course instructional design sequences objectives from simple
to complex so participants use and build upon previous learning as they progress. In CPR
and first aid training, instructors encourage participants to master the skills in the course
while at the same time avoiding any hint of the need for perfect performance (emphasizing
that “adequate care provided is better than perfect care withheld”). For participants, the major
benefit of performance-based instruction is reduced stress. Performance-based instruction
provides a positive and nurturing learning environment that helps reduce participant anxiety,
guilt and fear of imperfect performance. Also, performance-based as opposed to time-based
instruction reduces participant stress to master skills within a certain time period. Another
benefit of performance-based instruction is that it automatically adjusts for class size. The
more participants an instructor has, the more time is required to complete all the course
objectives. In a like manner, less participants can mean less required course time.
• Increased Skill Practice and Repetition. CPR and first aid skill retention requires ample
opportunities for participant practice to meet all psychomotor objectives. When key skills
and knowledge content are repeated throughout the instructional materials, along with
purposeful practice, the student builds toward skill mastery.
• Domain Inclusive Instruction. Effective CPR and first aid instruction includes all three
domains of learning – cognitive (mental skills, knowledge), affective (feelings, emotional and
attitude) and psychomotor (manual or physical skills).
• Context Based Instruction. When relevant, real-world training scenarios are part of the
course, participants are better able to apply what they’ve learned once the course is completed.
• Independent Study. Educational studies show that use of participant independent study
consistently produces well-prepared participants. Independent study also reduces the need
to establish base concepts in the classroom, allowing more time for skill development,
scenario practice, individual participant needs and regional variations. Through participant
independent study, knowledge development elaboration is minimized in the classroom. This
maximizes time for practice and reinforcing both critical information and important skills.
• Instructional Consistency. When course content and skill demonstrations are presented in
a consistent manner, using participant self-study materials (video, participant manual and
prompt cards such as the EFR Emergency Care at a Glance card), instructor variability and
classroom distractions are minimized.
• Relevant Participant Assessment. Participant assessment comes directly from the measurable
cognitive, affective and psychomotor objectives and performance requirements. Objective
and performance-based assessments serve not only as proof of participant competence and
mastery of objectives, but also as learning tools – correcting gaps in student understanding
and skill performance.
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Primary and Secondary Care Instructor Guide
Course Goals
The goals for both Emergency First Response Primary Care (CPR) and Secondary Care (First Aid)
courses are:
¨ Increase access to CPR education, increase effectiveness and efficiency of instruction,
improve skills retention, and reduce barriers to action for basic life support providers.
¨ Provide a positive and nurturing learning environment that reduces participant anxiety, guilt
and fear of imperfect performance.
¨ Teach a course that increases the percentage of CPR and first aid-trained laypersons who use
their skills without hesitation to assist those in need.
¨ Combine CPR and first aid into one Emergency Responder protocol.
¨ Teach a simple CPR and first aid protocol that promotes long-term memory retention by
participants.
¨ Maximize participant skill development and practice time, while minimizing instructor led
knowledge development (lectures).
¨ Teach a course following the latest ILCOR (International Liaison Committee on
Resuscitation) Basic Life Support guidelines, thus providing an internationally consistent
course flexible enough to accommodate regional CPR and first aid protocols and cultural
differences.
¨ Integrate participant independent study whenever possible for course efficiency and respect
for valuable participant time.
¨ Open and maintain an airway using the head tilt-chin lift or pistol grip technique.
¨ Provide effective rescue breaths (normal breaths of 1-second duration) that make the patient’s
chest rise. The rescue breaths may be given using the mouth-to-mouth, mouth-to-barrier, or
mouth-to-mask techniques.
¨ Perform complete CPR with chest compressions and rescue breathing at a rate of 30
compressions to 2 rescue breaths.
¨ Explain the importance and timeliness of defibrillation within the CPR and first aid protocol
and list the two ways it can be obtained (EMS and AED provided).
¨ Perform an emergency move and place a person in the recovery position.
¨ Demonstrate how to assist a conscious choking patient and/or an unconscious choking
patient consistent with local protocol.
¨ Manage serious external bleeding using direct pressure.
¨ Perform appropriate shock management.
¨ Stabilize and manage suspected spinal injury.
¨ Provide manual stabilization of suspected skeletal injuries when Emergency Medical Service
personnel will be delayed.
¨ Perform initial and ongoing assessments of an injured or ill person when Emergency Medical
Service personnel are either delayed or unavailable.
¨ Perform all skills in a manner that minimizes risk to the Emergency Responder, patient and
bystanders.
Course Structure
Both the Emergency First Response Primary Care (CPR)
and Secondary Care (First Aid) courses are divided into three
segments: 1) Knowledge Development, 2) Skill Development
and 3) Scenario Practice. Using the Emergency First Response
Participant Manual, participants may independently study
all required Knowledge Development material. With the
use of the Emergency First Response Video participants may
independently preview all required skills and skill applications.
There are three ways to organize and structure both courses:
1. Independent Study Approach – Use this approach
whenever possible as it is the most time efficient. This
course structure assumes participant independent study
of the Emergency First Response Participant Manual,
or Video prior to Instructor Led Skill Development and Scenario Practice. It also assumes
participants come prepared to review their completed Knowledge Review worksheet(s).
When using this approach you need not use the Knowledge Development Outlines in
Section Two. Avoid lecturing to participants when using the independent study approach.
The video contains basically the same background material as presented in the Emergency
First Response Participant Manual. Therefore, if a participant has not read the manual, having
watched the video would adequately prepare a participant to join in during skill development.
1-5
Primary and Secondary Care Instructor Guide
Instructor Role
The role of the Emergency First Response Instructor is to:
¨ Help participants feel at ease during the courses by providing them with a positive, relaxed
and low-stress learning environment.
¨ Demonstrate role-model quality skills and emphasize application during scenario discussions.
¨ Provide participants with positive and constructive instruction.
¨ Never rush participants through skill development. Individualize skill development time
based on each participant’s ability to meet performance requirements. Allow participants
plenty of time to practice.
¨ Emphasize the need for personal safety through scene assessments and barrier use.
¨ Encourage participants to use their knowledge and skills to assist those in need of emergency
care once they complete the course.
¨ Appropriately modify the course curriculum to meet regional guidelines, requirements or laws.
¨ Feel the reward and satisfaction of teaching others emergency care.
1-6
Section One – Course Overview and Standards
Course Standards
Who May Take the Courses?
Anyone interested in learning emergency care may take these
courses. There are no certification or licensure prerequisites for
the Emergency First Response Primary Care (CPR) course.
Also, there is no minimum age.
To participate in the Emergency First Response Secondary
Care (First Aid) course, individuals must complete the
Emergency First Response Primary Care (CPR) course or
another qualifying prerequisite course. Courses that qualify
are those teaching primary care (CPR) from any training
organization. Examples of a few organizations that teach
CPR-related courses are American Heart Association,
American Red Cross, American Safety and Health Institute, Cruz Roja de Mexico, Deutsches Rotes
Kreuz, MEDIC FIRST AID®, Inc., Queensland Ambulance Service, South African Red Cross
Society, Canadian Heart and Stroke Foundation and St. John’s Ambulance.
The Emergency First Response Secondary Care (First Aid) course builds upon the emergency care
skills learned in the Emergency First Response Primary Care (CPR) course. Therefore, give people
attending the Emergency First Response Secondary Care (First Aid) course who have taken
CPR training through another organization an orientation to these three Primary Care course
subject areas:
¨ Serious Bleeding Management
Standards in this section
¨ Shock Management may need modification based
¨ Spinal Injury Management on regional guidelines, laws or
requirements. For example, it may
Courses from other organizations may not include these be necessary to reduce participant-
critical skills needed for total patient care. To offset to-instructor-to-mannequin ratios,
this, participants may read those three segments in the etc. To meet regional guidelines,
participant manual and watch those three segments laws or requirements for Emergency
of the video prior to coming to the skill practice Responder/basic life support
session. Also, cover these primary care skills in your courses, you are encouraged to
demonstration and participant skill practice before communicate directly with your
moving into the Emergency First Response Secondary Emergency First Response Regional
Care (First Aid) course skills. Headquarters or the appropriate
organization, governmental body
or health and safety service in your
community or country.
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Primary and Secondary Care Instructor Guide
1-8
Section One – Course Overview and Standards
RECOMMENDED: RECOMMENDED:
• Blankets or towels for shock management • Emergency First Response Video
• Rugs or floor coverings for participant comfort • Emergency Care at a Glance
and protection during skill development
• Bag marked Biohazard for disposal of barriers to
show as example
• Different types of ventilation barriers to show as
examples
• Automated External Defibrillator (AED) unit or
AED trainer (optional skill)
• Extra adhesive pads to simulate AED pad
placement (optional skill)
• Oxygen unit (optional skill)
• Phone to simulate EMS call during scenarios
1-9
Primary and Secondary Care Instructor Guide
RECOMMENDED: RECOMMENDED:
• Phone to simulate EMS call during scenarios • Emergency First Response Video
• Emergency Care at a Glance
1-10
Section One – Course Overview and Standards
1-11
Primary and Secondary Care Instructor Guide
Membership Commitment
The Emergency First Response organization’s success comes from many factors not the least of
which is the professionalism and excellence demonstrated by Emergency First Response Instructors
and Trainers. When you become an Emergency First Response Instructor, you agree to abide
by standards and procedures described in Emergency First Response instructor guides for the
Emergency First Response courses you teach. In this way, Emergency First Response courses have
common consistency throughout the world.
Everyone benefits when you use the educational system as intended and when you comply with the
standards within it: Participants receive thorough training; instructors enhance their courses by using
a tested educational system; and the Emergency First Response organization’s reputation for quality
remains intact. Emergency First Response Headquarters throughout the world provide you education,
guidance and counseling regarding your use of the Emergency First Response system of education.
Emergency First Response monitors courses for quality control by sending course evaluation
questionnaires to participants. These surveys ask participants specific questions about their training
and how they were instructed. When survey participants provide answers that indicate possible
noncompliance with Emergency First Response Standards, the Regional Headquarters follows
up with the instructor. The Quality Management Committee at Emergency First Response is
committed to excellence and handles all such issues using standardized procedures that are based on
equal application. The process is proactive and helps to ensure that all instructors understand their
responsibility to adhere to Emergency First Response standards and procedures. When there is a
problem in this area, Emergency First Response will make every effort to reorient the instructor to
standards and get the instructor back on track. In rare instances an instructor may be required to
retrain; or, when the seriousness of a situation justifies it, the instructor may no longer be eligible to
teach Emergency First Response courses.
Code of Practice
Along with the benefits they receive, Emergency First Response Instructors take on the
responsibility to conduct themselves appropriately as professionals. The following ethical
requirements define how Emergency First Response Instructors are expected to interact with
Emergency First Response, other Emergency First Response Instructors and the Emergency First
Response community in general.
As an Emergency First Response Instructor, you agree to:
1. Abide by the requirements and intent of Emergency First Response Standards and procedures
as published in the Emergency First Response Instructor Manual, The Responder and other
updates while conducting Emergency First Response courses and programs.
2. Conduct yourself and your Emergency First Response-related activities in a professional
manner.
3. Represent yourself as an Emergency First Response Instructor only when you are in Teaching
status.
4. Not disparage the Emergency First Response organization, Emergency First Response
Instructors or any other industry professionals.
5. Exhibit common honesty in your Emergency First Response related activities.
6. Cooperate during official Emergency First Response investigations by responding fully and
promptly to inquiries.
1-12
Section One – Course Overview and Standards
7. Accept that a criminal conviction involving abuse of a minor either during or prior to
becoming an Emergency First Response Instructor is grounds for denial or termination of
your instructor status.
8. Accept that a criminal conviction involving sexual abuse of an adult either during or prior to
becoming an Emergency First Response Instructor is grounds for denial or termination of
your instructor status.
9. Follow a strict code of conduct and abide by the requirements and intent of the Youth
Leader’s Commitment whenever teaching or supervising children.
®
Emergency First Response Instructor Renewal
Requirements
To maintain authorization to teach, you must renew your Emergency First Response Instructor
rating every two years and agree to stay up-to-date with Emergency First Response course
standards and implement any changes announced in The Responder.
If your renewal lapses and the term of your Emergency First Response Instructor credential expires,
contact your Emergency First Response Regional Headquarters for information on how you can
reactivate your authorization to teach.
You may need to fulfill other requirements such as attending a refresher, if local requirements must
be met or major program revisions or significant standards changes occur. Where legally required for
official recognition, other renewal requirements may apply. Check your Emergency First Response
Instructor Renewal Application for specifics or contact your Emergency First Response Regional
Headquarters.
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Primary and Secondary Care Instructor Guide
Course Sequence
Use this recommended course sequence to organize training sessions and meet program requirements.
You may adapt this schedule to meet participant needs and to fulfill local requirements.
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Section One – Course Overview and Standards
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Section Two – Knowledge Development
Two
Knowledge Development
When materials are available, participants should study the course information independently using
the Emergency First Response Participant Manual, and Video. In situations where the manual, and
video are not available in a language participants understand, use the Knowledge Development
Outlines in this section to elaborate on necessary information. Use these outlines for both the
Emergency First Response Primary Care (CPR) and Secondary Care (First Aid) courses.
Independent Study
Independent study has several major educational and logistical advantages.
1. Better participant preparation. Research shows that participants who study independently,
learn better. Primary reasons include: 1) allows participants to learn at their own pace and
2) better accommodation of individual learning styles. Both of these contribute to effective
learning and better preparation before skill development. Participants viewing the video will
be better prepared to participate in the Skill Development and Scenario Practice sessions.
2. More effective use of time. Independent study of CPR and first aid background information in
the Emergency First Response Participant Manual allows instructors to focus completely on Skill
Development and Scenario Practice. Also, participants watching Skill Development segments in
the Emergency First Response Video are better prepared for hands-on training than those who did
not see a preview. This makes courses shorter, accommodating individuals with busy schedules.
3. Ability to focus on regional CPR and first aid differences. When participants independently
study the background CPR and first aid information, you can focus class time on reviewing
information and teaching optional skills required by regional CPR and first aid governing bodies.
4. Better business opportunities. Since independent study allows for shorter instructor-to-
participant contact time, you can price your Emergency First Response Primary Care (CPR)
and Secondary Care (First Aid) courses competitively. In contrast, course flexibility also allows
you to add time as needed, or required, by a client or regional governing body.
5. Better use of instructor time. An Emergency First Response Instructor’s time is best spent
conducting the Skill Development and Scenario Practice sessions. Further, independent
study media cannot address specific participant needs and issues while at the same time
orienting him to specific regional training protocols and needs. Only an instructor can
accomplish this. Only an instructor can evaluate a participant’s learning progress and first aid
skills, plus recommend specific remedial training.
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d. Both courses use the same, singular emergency care procedure. This will help you
remember what to do when a real life emergency raises your stress.
2. Prerequisite Course Flow
a. You must complete the Emergency First Response Primary Care (CPR) course before taking
the Secondary Care (First Aid) course.
b. This requirement exists because anytime you approach a patient and provide emergency
care, regardless of the injury or illness, you always begin with the skills you learn in the
Emergency First Response Primary Care (CPR) course.
c. You need the skills learned in the Primary Care (CPR) course to adequately deliver
secondary care (first aid) to an injured or ill patient. You never know when the patient
could get worse and need priority care.
3. Who May Enroll
a. Anyone of any age may enroll in the Emergency First Response Primary Care (CPR)
course. Since the course is performance-based, if you complete the requirements you can
receive a course completion card.
4. Primary Care Skills
a. Skill 1 - Scene Assessment
b. Skill 2 - Barrier Use
c. Skill 3 - Primary Assessment
d. Skill 4 – CPR: Chest Compressions
e. Skill 5 - CPR: Chest Compressions Combined With Rescue Breathing
f. Optional Skill – Automated External Defibrillator Use
g. Skill 6 - Serious Bleeding Management
h. Skill 7 - Shock Management
i. Skill 8 - Spinal Injury Management
j. Skill 9 - Conscious/Unconscious Choking Adult
k. Optional Skill - Emergency Oxygen Use Orientation
5. Secondary Care Skills:
a. Skill 1 - Injury Assessment
b. Skill 2 - Illness Assessment
c. Skill 3 - Bandaging
d. Skill 4 - Splinting for Dislocations and Fractures
6. The Secondary Care (First Aid) course complements the Emergency First Response Primary
Care (CPR) course by introducing additional first aid skills. You will continue to refine your
primary care assessments and discover different ways to assist those needing emergency care
when professional medical care is either delayed or unavailable. We would encourage you to
enroll and complete this course if you have not already done so.
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Section Two – Knowledge Development
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Section Two – Knowledge Development
3. There are six ways you should act to be protected by Good Samaritan laws.
They are:
a. Only provide care that is within the scope of your training as an Emergency Responder.
b. Ask for permission to help.
c. Act in good faith.
d. Do not be reckless or negligent.
e. Act as a prudent person would.
f. Do not abandon the patient once you begin care. The exception to this is if you must do
so to protect yourself from imminent danger.
INSTRUCTOR NOTE – Local laws may vary on how to act to be protected by Good
Samaritan laws.
Chain of Survival
Early Recognition and Early CPR Early Automated External Early Professional Care
Call for Help Defibrillation (AED) and Follow-up
combined with CPR
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2. When you recognize a potentially life-threatening emergency, you help with the first three links
in the Chain of Survival. The fourth link involves only professional emergency care providers –
EMTs, Paramedics, nurses and doctors. Here are the four links in the Chain of Survival:
a. Early Recognition and Call for Help. As an Emergency Responder, you must first
recognize that an emergency exists and evaluate the scene to determine whether you can
safely assist the patient. This link involves you, the Emergency Responder. For a patient
with a life-threatening problem, rapid activation of EMS is critical. This is the Call First
concept. Further, ask someone to bring an automated external defibrillator (AED), if one
is available.
INSTRUCTOR NOTE – Discuss why this step is located at this point within the Chain
of Survival. For a patient with a life-threatening problem, rapid activation of EMS is
critical. This is the Call First concept. Tell participants that there is more on this later.
b. Early CPR. A person who is not breathing normally and has no heartbeat needs CPR
immediately. Early CPR is the best treatment for cardiac arrest until a defibrillator and
more advanced trained professionals arrive. Effective and immediate chest compressions
prolong the window of time during which defibrillation can occur and provides a small
amount of blood flow to the heart, brain, and other vital organs. Immediate CPR can
double or triple a patient’s chance of survival from irregular heartbeats or sudden cardiac
arrest. This link also involves you, the Emergency Responder.
c. Early Defibrillation. Combined with CPR, early
defibrillation by you, the Emergency Responder,
or EMS personnel, can significantly increase the
probability of survival of a patient in cardiac arrest.
During your Primary Care course, you may learn
how to use an Automated External Defibrillator
(AED). If you witness a cardiac arrest and an AED
is immediately available, you should begin chest
compressions and use the AED as soon as possible
(more on this later). When applied to a person in
cardiac arrest, an AED automatically analyzes the
patient’s heart rhythm and indicates if an electric
shock is needed to help restore a normal heartbeat. If
you learn how to use an AED in this course, this link
involves you, the Emergency Responder. Most EMS
personnel also use AED units.
d. Early Professional Care and Follow-up. EMS personnel can provide advanced patient
care that you can not. The advanced care EMS personnel can provide includes artificial
airways, oxygen, cardiac drugs and defibrillation (when an AED is unavailable). After
initial on-scene care, EMS personnel take the patient to the hospital for more advanced
medical procedures. The patient remains hospitalized until no longer needing constant,
direct medical attention.
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4. With EMS on the way, the care you provide increases the chance that advanced care will help
the patient when it arrives. Your training in this course is based on handling emergencies
where you have an Emergency Medical System. If you may need to provide emergency aid in
areas away from EMS support, you should continue your education with more advanced first
aid training.
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2. You can practice and fine-tune your skills by enrolling in an Emergency First Response
Refresher course.
a. During the refresher, you’ll practice your skills by once again completing just the Skill
Development portion of an Emergency First Response course (Primary Care, Secondary
Care and/or Care for Children). You’ll also retake the exam as part of the refresher
course.
b. By completing a refresher, you’ll be issued a new Emergency First Response completion
card.
c. It’s a good idea to take a refresher course at least every 12 to 24 months to keep your skills
and completion card current. In some areas, regional guidelines highlight the need for
frequent skill review and practice.
d. Our next Emergency First Response Refresher course is: _________.
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Section Two – Knowledge Development
4. There are other ways to lead an all-around healthy lifestyle. Consider the following.
a. Learn to relax, but don’t be lethargic.
b. Manage stress. Don’t merely focus on how to avoid it.
c. Take care of yourself so you are able to function effectively as an Emergency Responder.
Helping others in their time of need will put stress on your body – both emotionally and
physically.
1. When possible, place a barrier between you and any moist or wet substance originating from
another person.
2. All blood and body fluid should be considered potentially infectious. Take precautions to
protect yourself against them:
E. Four Ways to Protect Yourself against Disease Transmission
1. Use gloves
2. Use ventilation masks or shields when giving mouth-to-mouth rescue breathing.
3. Use eye or face shields; including eyeglasses or sunglasses, goggles and face masks.
4. Always wash your hands or any other area with antibacterial soap and water after providing
primary (CPR) and secondary (first aid) care. Scrub vigorously, creating lots of lather. If
water is not available, use antibacterial wipes or soapless liquids.
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3. If a patient’s heart has stopped, you substitute manual chest compressions for the heart’s
pumping action to circulate blood through the body.
4. Chest compressions force blood from the heart through the arteries and deliver oxygen-rich
blood to vital organs.
INSTRUCTOR NOTE – Delays in, and interruptions of, chest compressions should
be minimized whenever you assist someone who is unresponsive and not breathing
normally. Chest compressions can be started immediately. Delaying chest
compressions for any reason is counterproductive.
5. Manual chest compressions deliver no more than one third of normal blood flow to the
body. Therefore, as an Emergency Responder you must begin compressions immediately
and minimize interruptions during CPR. Delaying chest compressions for any reason is
counterproductive.
6. CPR is used as an interim emergency care procedure until an AED and/or EMS personnel
arrive. However, it is a vital link in the Chain of Survival. CPR extends the window of
opportunity for resuscitation – greatly increasing the patient’s chance of revival.
7. CPR rescue efforts are difficult to sustain for long periods. From an Emergency Responder
perspective, CPR is exhausting. This is another reason to call the EMS immediately. Also, if
feasible, change rescuers every few minutes to prevent rescuer fatigue and deterioration in
chest compression quality.
8. Regarding CPR, if you are unable or feel uncomfortable giving a nonbreathing patient
rescue breaths – RELAX! Simply give the patient continuous chest compressions. Chest
compressions alone are very beneficial to a patient who is unresponsive and not breathing
normally. Your efforts may still help circulate blood that contains some oxygen. Remember:
Adequate care provided is better than perfect care withheld.
9. You will learn adult CPR during the Primary Care Skill Development session.
F. Unresponsive Patients Who Are Not Breathing Normally
1. Rapid recognition of cardiac arrest is important when helping someone who is unresponsive,
not breathing or not breathing normally. Unresponsive patients who are not breathing
normally may be in cardiac arrest.
2. After you’ve determined that a patient is unresponsive and not breathing normally, activate
the Emergency Medical System immediately.
3. Next, you begin CPR, chest compressions.
4. What does unresponsive mean? A patient who is unresponsive shows no sign of movement
and does not respond to stimulation, such as a tap on the collarbone or loud talking. This is
also known as unconsciousness.
5. What does “not breathing normally” mean? An unresponsive person taking gasping breaths is
NOT breathing normally. In the first few minutes after cardiac arrest, a patient may be barely
breathing, or taking infrequent, slow and noisy gasps. Do not confuse this with normal breathing.
A patient barely breathing, or taking infrequent, slow and noisy gasps needs CPR immediately.
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INSTRUCTOR NOTE – Do not take time to check for a pulse. Studies show that
even healthcare providers have difficulty detecting a pulse on unresponsive
patients. Checking for a pulse takes too much time – time that can be used to
immediately initiate CPR.
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AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
2. When you first begin to assist a patient with a life-threatening illness or injury, reflect on the
AB-CABS graphic. First begin with the “AB” portion of the memory word. This is a quick
check of the patient’s Airway to see if it’s open and if the patient is Breathing normally.
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3. Next, move to the “CAB” portion of the memory word (in the blue sphere). If the patient
is not breathing normally you must act immediately to provide Chest Compressions. After
chest compressions you open the patient’s Airway and then Breathe for the patient (CAB).
As defined earlier, this is how CPR is administered.
4. Once you are finished providing rescue breaths for the patient, you return to Chest
Compressions and begin again. You continue CPR in a continuous cycle of chest compressions
and rescue breaths. We call this the Cycle of Care.
5. If a patient is breathing normally, then he does not need CPR. You SKIP all the steps in the
blue sphere – the CAB portion of the memory word.
6. If the patient is breathing normally you move along the Cycle of Care to the S portion of “CABS”
and treat for Serious bleeding, Shock and Spinal injury.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
7. Notice that if you are performing CPR on a patient that is not breathing normally you
continue with Chest Compressions, opening the Airway and providing rescue Breaths –
CAB. You do not attempt to treat the patient for serious bleeding, shock and spinal injury.
CPR takes priority over all other concerns.
E. Continually Move Through The Cycle of Care
1. Regardless of the patient’s situation upon your arrival, you begin a primary assessment using
the memory word AB-CABS to help you remember how to begin and what steps to follow.
Remember the word AB-CABS and think of the Cycle of Care graphic.
2. The phrase, “Continually move through the Cycle of Care” helps you maintain appropriate
primary care sequencing.
3. In a continual Cycle of Care you apply CPR, remembering the CAB portion of the memory
word. You do this until professional help (ambulance or Emergency Medical Services) arrives
or an Automated External Defibrillator (AED) is located and brought to the patient. More
on AED’s later.
4. Let’s apply the priorities indicated by the Cycle of Care to two different situations.
Situation One. You are alone and find a patient lying in his yard. He is unresponsive and not
breathing normally. He has fallen on a sharp gardening implement and it’s impaled his leg. His
leg is bleeding. For this patient, what is the sequence of emergency care?
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INSTRUCTOR NOTE: Break participants into groups. Using the Cycle of Care,
have them explain the order of emergency care priorities and what they would
do to help this person. Keep the discussion general and focused on the Cycle
of Care. Answers may vary depending on how bad the patient is bleeding. In
general however, using the Cycle of Care the rescuer would: 1) Assess the scene
for unknown dangers to yourself and the patient and apply barriers, 2) Check
for an open airway and normal breathing, 3) Alert EMS, 4) Provide patient with
chest compressions, 5) Open the patient’s airway, 6) Provide patient with rescue
breaths, 7) Continue CPR until help or an AED arrives.
Situation Two. A painter falls from a tall ladder onto cement. When you find him he is moaning and
talking, but obviously hurt. For this patient, what is the proper sequence of emergency care?
INSTRUCTOR NOTE – Again, have the groups explain the order of emergency care
priorities and what they would do the help this person by using the Cycle of Care.
Of course in this example, the rescuer would provide care for possible bleeding,
shock and spinal injury. Keep the discussion general and focused on the Cycle of
Care. Answers may vary, but in general using the Cycle of Care the rescuer would:
1) Assess the scene for unknown dangers to yourself and the patient, 2) Check
for an open airway and normal breathing, 3) Alert EMS, 4) Look for and treat
suspected bleeding, shock and/or spinal injury, 5) Continually move through the
Cycle of Care until EMS arrives.
In this situation the patient is responsive and talking. If a patient talks and
moans, then he has an open airway and is breathing. He does not need CPR,
so you skip the CAB portion of the Cycle of Care. You would provide care for
possible Serious bleeding, Shock and/or Spinal injury.
F. Cycle of Care
1. On the AB-CABS Cycle of Care graphic you continually move from Chest Compressions, to
Airway Opening, to Breathing for the patient, and then back to Chest Compressions.
2. You continue this Cycle of Care until either EMS personnel arrive and take over or an AED is
located and brought to the patient.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
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AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
1. If a patient’s Airway is open and he’s Breathing normally (AB), then there is NO need to:
• Provide Chest Compressions.
• Make sure the Airway is open.
• Or Breathe for the patient.
2. There is no need to act on the CAB portion of the Cycle of Care.
3. Next, you move on to check the patient for Serious bleeding, Shock, and Spinal Injury. These
comprise the “S” in the word CABS. Let’s look at each separately.
J. Serious Bleeding
1. Serious bleeding is life-threatening. It must be discovered and managed during the primary
assessment.
2. The human body contains about six litres/quarts of blood. Rapid loss of even one litre/quart
can lead to death.
3. The three types of bleeding are:
a. Arterial Bleeding – bright red blood that spurts from a wound in rhythm with the
heartbeat. This is the most serious type of bleeding since blood loss occurs very quickly.
If a major artery is cut, death can occur in one minute if not treated. Activate EMS
immediately.
b. Venous Bleeding – dark red blood that steadily flows from a usually deep wound. Venous
bleeding does not display rhythmic spurts. This bleeding is also life-threatening and must
be controlled. Monitor the patient’s Cycle of Care and activate your local EMS
c. Capillary Bleeding – Slow bleeding that is typically controllable. Monitor the patient’s
Cycle of Care and activate EMS if necessary.
4. During the Skill Development session, you will learn how to control bleeding and provide
emergency care.
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K. Shock
1. Any injury or illness, serious or minor that stresses the body, may result in shock. In reaction
to a medical condition, the body pools blood into one or more vital organs. This reduces
normal blood flow to other body tissues depriving cells of oxygen. During shock, the body
begins to shut down.
2. Nine common signs of shock are:
a. Rapid, weak pulse
b. Pale or bluish tissue color
c. Moist, clammy skin – possibly with shivering
d. Mental confusion, anxiety, restlessness or irritability
e. Altered consciousness
f. Nausea and perhaps vomiting
g Thirst
h. Lackluster eyes, dazed look
i Shallow, but rapid, labored breathing
3. Even if you don’t recognize any of these signs and symptoms in a patient, continue to
manage for shock when you provide emergency care to an injured or ill patient.
4. It’s better to prevent shock than to let it complicate a patient’s condition
5. During primary assessment and care, you take the first steps to managing shock by dealing
with other life-threatening conditions. Checking that a patient is breathing, has adequate
circulation and is not bleeding profusely helps the patient’s body maintain normal blood
flow. You render additional care by keeping the patient still and maintaining the patient’s
body temperature. You may elevate the patient’s legs if it won’t aggravate another injury.
Continuing to monitor the patient’s lifeline until EMS arrives also contributes to shock
management.
6. During the Skill Development session, you will learn how to control shock and provide
emergency care.
L. Spinal Injury
1. Your spinal cord connects the brain to the rest of the body and organs.
2. It is essential for life and runs down through the vertebrae in the neck and spine.
3. Vertebrae are rings of bones surrounding the spinal cord and run from the neck to the lower
back. These bones make up the backbone, or spinal column.
4. A spinal cord injury may result in permanent paralysis or death. The higher up in the
spinal column the injury, the more likely it will cause a serious disability. This is why it’s so
important to guard the head, neck and spine when attending to an injured patient.
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M. Nine Indications Signaling the Possible Need for Spinal Injury Management
1. Change of consciousness – like fainting
2. Difficulty breathing
3. Vision problems
4. Inability to move a body part
5. Headache
6. Vomiting
7. Loss of balance
8. Tingling or numbness in hands, fingers and feet and/or toes
9. Pain in back of neck area
N. When You Should Always Suspect a Spinal Injury
INSTRUCTOR NOTE – There may be other circumstances when you should suspect
a spinal injury, but in these cases you should always suspect a spinal injury.
1. Traffic/car accident
2. Being thrown from a motorized vehicle
3. Falling from a height greater than patient’s own height
4. A penetration wound, such as a gunshot wound
5. Severe blow to the head, neck or back
6. Swimming pool, head-first dive accident
7. Lightning strike
8. Serious impact injury
9. Patient complains of pain in neck or back
O. Protecting the Spinal Cord During Primary Care
1. Important Primary Care Concept: Never move a patient unless absolutely necessary.
2. If a spinal cord injury is suspected during the primary assessment, support the head and
minimize its movement during CPR or other emergency care.
3. During skill development, you’ll practice turning a patient while protecting the neck
and spine. This technique for moving a patient is called the log roll. You’ll learn to roll a
patient by yourself and with the assistance of another Emergency Responder.
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b. Also, primary care skills are needed during this course. Further, at any time a responsive patient
can become unresponsive and even stop breathing thereby needing Primary Care – CPR.
3. Skills Learned in the Emergency First Response Secondary Care (First Aid) Course
a. Skill 1 - Injury Assessment
b. Skill 2 - Illness Assessment
c. Skill 3 - Bandaging
d. Skill 4 – Splinting for Dislocations and Fractures
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Section Three – Skill Development
Three
Skill Development
Introduction
Skill development is a critical part of the
Emergency First Response program. Participants
first learn the basic steps and subskills, then
practice the skills under peer and instructor
guidance. Repeated practice under controlled
conditions allows participants to fine-tune
performance, gain competence and build for
retention.
This section provides information about teaching
primary care and secondary care skills. It also
includes guidelines for introducing two optional
course skills – Automated External Defibrillator (AED) and Emergency Oxygen Use. By following
step-by-step directions for organizing skill development, you’ll introduce skills, guide practice and
answer participant questions about techniques covered in the Emergency First Response Participant
Manual and the Emergency First Response Video. During skill development, you’ll also provide
participants with encouragement and suggestions for improvement.
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Practice Groups
Why and How
Learning skills require focus, participation, and practice. By dividing participants into small practice
groups, you provide them with a comfortable learning environment that continually engages them
in skill practice. Ideal practice groups consist of a guide, a patient and an Emergency Responder.
The group members alternate roles until all participants have the opportunity to play each role. This
approach allows participants to perform not only a skill, but to also see someone else practice the
skill and to feel what a patient may experience.
When acting as a guide, the participant helps the Emergency Responder through the skill by reading
the How It’s Done steps in the Skill Development section of the Emergency First Response Participant
Manual. Having to direct a peer helps each participant understand the skill steps and increases
overall confidence.
Practicing the skill as the Emergency Responder, especially the first attempt, becomes less stressful
when participants know that a peer is available to guide them. Making initial mistakes in front of
other participants, instead of the instructor, is less intimidating for many people. Practicing in a
group also strongly promotes self-discovery and self-correction.
Having participants act as patients serves two important purposes. First, it adds realism by requiring
the Emergency Responder to approach, touch and
interact with another person. Secondly, it allows
participants to examine emergency care from a
patient’s perspective. This heightens awareness and
reinforces the need to help others whenever possible.
The ideal practice group is made up of three
participants. However, if class size doesn’t allow this
division, place four participants in a group or use
smaller groups with you or an assistant filling in as
necessary. For larger classes, consider reorganizing
groups once or twice during the course to keep
interest levels high.
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Section Three – Skill Development
Positive Coaching –
Encouraging Good Technique
Points to keep in mind during skills practice:
1. If the participant is obviously anxious about the skill, and/or if it is the first time the skill
is practiced, it is often best to let the participant follow through with the skill regardless of
ineffectiveness. Interrupting the skill to correct technique in this situation can cause further
anxiety. Be mindful that the participant is not only performing the skill, but also trying to recall
the sequence and steps of each skill. Work on the sequence first, then technique.
2. There are several nonthreatening ways to correct ineffective technique without singling out or
drawing attention to (and thus embarrassing) any one participant. For example, after the skill
is performed ineffectively, one method is to thank the person, move on to the next participant,
and point out the most effective things that person is doing. By drawing attention to specific,
effective techniques in other participant performance, it sends a message to all participants as to
what you are looking for in performance. This method of “gentle correction” also keeps the class
moving. Be prepared for further practice as those with ineffective technique learn from others
and repeat practice.
3. Another method is to provide impromptu demonstrations yourself (or by your assistant), pointing
out specific elements of the skill you want participants to correct.
4. You can also use the Emergency First Response Video skill demonstrations, turning off the sound,
and pointing out technique during the demonstration.
5. Keep your critiques positive. Give participants encouragement, even when they are performing
poorly. Let them learn by discovery and by watching others, whenever possible. Avoid singling
anyone out and causing embarrassment. Make broad statements such as “I noticed some of you
were ____________________ (name specific problem). It can be more effective to do it like this
[demonstrate technique].”
6. Ask participants to encourage each other and work together for success in their practice groups.
Make sure the “guide” helps the Emergency Responder by reading through the steps and
technique suggestions as needed.
7. Avoid standing over your participants while they perform skills—take a nonthreatening stance, a
bit away, but near enough to monitor and assist as needed.
8. Always commend good technique, and be specific about it. Pointing out effective skills practice
in this manner builds confidence and helps others learn.
Remember that creating a nonthreatening, positive atmosphere in class will promote effective skills
practice, skill retention, and foster a willingness to offer skills in an emergency.
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Section Three – Skill Development
In general, you introduce each skill by reviewing the performance requirement, value and key points.
Next, you provide a demonstration, as necessary, using the critical steps. After dividing participants
into practice groups, you monitor practice, provide positive reinforcement, and offer suggestions for
improved technique. Allow for additional practice as necessary to increase participant competence and
confidence.
Because you may have several practice groups working on skills at the same time, make sure you can
adequately supervise development, answer questions, and advise participants. Remember to keep
answers to questions brief and to the point. Consider answering situational or “what-if ” questions by
sending participants back through the Cycle of Care to continually monitor medical status.
Skill development motivates and teaches participants proper emergency care procedures for patients
suffering what might be life-threatening injuries. Stress that the goal is to apply knowledge to actual
circumstances if the need arises.
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Skill Development
Primary Care (CPR)
Primary Care Skill 1
Scene Assessment
Performance Requirement
Demonstrate procedures for assessing an emergency scene for safety.
Value
As an Emergency Responder, you must ensure your safety before you can provide emergency care to
someone in need. You cannot provide care if you become injured. Always assess the scene for safety.
Assess Scene AB C
Chest
Airway Breathing
Apply Barriers
Open? Normally?
Compressions
AA irway Open
Airway Open?
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
The first “A” in the memory word AB-CABS can mean more
than simply asking the question “Airway Open?” It can also
remind you to Assess the Scene.
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Section Three – Skill Development
Skill Practice
Using the scene assessment illustrations (in either the participant manual or this guide), have
participants work through one or more of the four accidents illustrated – stopping, thinking and
acting in practice groups. Also, provide participants with local contact information to Alert EMS.
Debrief
Allow for additional practice as necessary to increase participant competence and confidence. Tell
participants that they will assess a scene every time they step up to provide care.
3-7
Primary and Secondary Care Instructor Guide
Scene Assessment
3-8
Section Three – Skill Development
Scene Assessment
3-9
Primary and Secondary Care Instructor Guide
Barrier Use
Performance Requirement
Demonstrate procedures for donning, removing and disposing of gloves. This includes removing
gloves without snapping or tearing them. Also, properly position a ventilation barrier on a
mannequin.
Value
Barriers provide protection from the transmission of infectious diseases. Barriers, if available, should
be used to ensure your safety and the patient’s safety.
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
The first “A” in the memory word AB-CABS can mean
more than simply asking the question “Airway Open?”
It can also remind you to Apply Barriers.
Key Points
¨ Remember to STOP, THINK and then ACT.
¨ Barriers include gloves, ventilation barriers, eye shields and
face masks.
¨ IMPORTANT: Do NOT delay emergency patient care if
barriers are not available. Research has shown that the chance
of disease transmission is very rare when providing CPR.
¨ If gloves and ventilation barriers are immediately available, use
them during CPR to protect yourself and the patient from possible
disease transmission.
¨ If available, also use eye shields and face masks when patients have
serious bleeding.
¨ Prior to and after all skill practice, wash your hands. After providing
actual emergency care, make sure you wash your hands.
3-10
Section Three – Skill Development
Critical Steps
Gloves On
1. Quickly put on gloves. Pull them on carefully to avoid tearing. Consider removing sharp
rings on fingers.
Gloves Off
1. To remove the first soiled glove, carefully pinch the
outside portion of the glove at the wrist. Avoid contact
with the outside of the glove. Be careful not to snap or
tear the glove during removal since fluids may disperse
inappropriately.
2. Gently roll the glove off so that the outside portion is
turned inside. Hold the removed glove with the gloved
hand.
3. To remove the remaining glove, place the ungloved hand under the glove at the wrist, next
to the skin, and roll off in the same manner. Roll the glove off and around the previously
removed glove.
4. After removing both gloves, place them in a biohazard bag for disposal.
Ventilation Barriers
Refer participants to their Emergency First Response Participant Manual to review the different types
of ventilation barriers – shields, pocket masks, etc. If possible provide samples of various barriers.
1. Place ventilation barrier over patient’s mouth and/or nose for CPR.
2. Position barrier to allow rescue breaths but prevent the patient’s body fluids from reaching you.
3. Place used disposable ventilation barrier in a biohazard bag.
Skill Practice
INSTRUCTOR NOTE – If a participant has a sensitivity to Latex®, use a glove made
of a different material such as nitrite or vinyl.
In practice groups and following the steps in Emergency First Response Participant Manual, have
participants develop proper techniques for putting on, removal and disposal of gloves. Have
participants also practice placing a ventilation barrier on mannequin.
Debrief
Allow for additional practice as necessary to increase participant competence and confidence.
Discuss or show participants other types of barriers if available – eye shields and face masks. Further,
discuss the need for hand or body washing after emergency care when exposed to body fluids.
3-11
Primary and Secondary Care Instructor Guide
Performance Requirements
Demonstrate how to:
¨ Perform a patient responsiveness check by giving the Responder Statement and tapping the
patient’s collarbone.
¨ Check for an open airway using one of two methods - head tilt-chin lift or pistol grip lift.
¨ Check for normal breathing.
¨ Perform a Primary Assessment on a responsive and conscious patient.
¨ Perform a Primary Assessment on an unresponsive and unconscious patient.
¨ Place an unresponsive, breathing patient in the recovery position.
Value
Remember, “primary” means first in a series or sequence. “Assessment” is an evaluation or an
appraisal. Primary assessment helps you recognize life-threatening conditions and prepare to
provide priority emergency care. By conducting a Primary Assessment you will be able to answer
the questions is the Airway Open and is the patient Breathing Normally? This is the “AB” portion of
AB-CABS memory word. After you conduct a Primary Assessment, then you proceed to attend to
life-threatening conditions.
Key Points
¨ Use the Cycle of Care memory word to help you conduct a Primary Assessment.
¨ Deliver the Responder Statement and tap collarbone to check for patient responsiveness.
¨ Check for normal breathing. If the patient is not breathing or is only gasping, then he needs
CPR.
¨ Avoid delaying emergency care by taking the time to locate and put on barriers.
3-12
Section Three – Skill Development
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
¨ If an unresponsive patient is obviously breathing normally, use the Cycle of Care to continually
monitor his medical status. Check for Serious bleeding, Shock or Spinal injury. Next, put the
patient in the recovery position.
¨ The recovery position relieves pressure on the patient’s chest, allowing the patient to breathe
more easily. It also ensures the airway remains open and unobstructed while at the same time
decreases the risk of something blocking his airway, and allows fluids to drain should he
vomit.
The first “A” in AB-CABS helps you remember to answer the question:
A = Airway Open?
¨ After you deliver your Responder Statement you can quickly check for an open Airway on
the patient. You’ll learn how to open an airway in this skill.
The first “B” in AB-CABS helps you remember to answer the question:
B = Breathing Normally?
¨ Quickly check to see if the patient is breathing normally. A patient barely breathing, or
taking infrequent, slow and noisy gasps is not breathing normally. Gasping is a common sign
or cardiac arrest in an unresponsive patient.
3-13
Primary and Secondary Care Instructor Guide
The “CABS” portion of the memory word AB-CABS reminds you of the priority order necessary
to care for a patient:
C = Chest Compressions
¨ You’ll learn how to perform Chest Compressions in Skill 4: CPR – Chest Compressions.
A = Airway Open
¨ Before you can provide a patient with rescue breathing, you’ll need to open the patient’s
airway.
3-14
Section Three – Skill Development
3. If the patient is not responsive or breathing normally, ask a bystander to call EMS and secure
an AED if possible. If you are alone, use your mobile phone to call EMS. If you do not have
a mobile phone, leave the patient to call EMS if no other option exists. This is the Call First
approach to emergency care. You Call First to activate Emergency Medical Services, then
you provide assistance.
4. Put on barriers if immediately at hand. Do not delay emergency care if barriers are absent.
5. If the patient is unresponsive and not breathing normally, immediately begin giving CPR.
(You will learn CPR in the next skill. DO NOT PRACTICE CPR ON A FELLOW
CLASS MEMBER.)
6. If the patient is breathing normally, continue your Primary Assessment with the “S” portion
of the memory word CABS – check for Serious bleeding, Shock and Spinal injury. (You
learn how to manage these emergency care concerns later.)
3-15
Primary and Secondary Care Instructor Guide
Skill Practice
In practice groups using the Emergency First Response Participant
Manual, have participants perform a Primary Assessment on a responsive
patient and also on an unresponsive patient who is not breathing normally.
One person is the guide, reading the steps; one is the patient, while the other is the Emergency
Responder. Make sure everyone has the chance to act as the Emergency Responder. Also, for an
unresponsive, normal breathing patient have participants practice putting the patient in the recovery
position.
Remind participants to take their time. There is no time pressure. As CPR and care for serious
bleeding, shock or spinal injury management have not been covered, these skills are not practiced
yet. Even though subsequent skills are referred to, it’s important to introduce skills in order and not
overwhelm participants with too much information.
Debrief
Conclude with a role model, real-time demonstration on an unresponsive, normally breathing
patient. Allow for additional practice as necessary to increase participant competence and confidence.
3-16
Section Three – Skill Development
Performance Requirements
Demonstrate how to:
¨ Perform adult CPR – chest compressions at a rate of at least 100 chest compressions per
minute and depressing the chest approximately one-third the depth of chest – at least 5
cm/2 inches.
¨ Minimize interruptions in chest compressions.
Value
When a patient stops breathing and his heart is beating erratically or not at all, you can substitute
manual Chest Compressions for the heart’s normal pumping action to circulate blood through the
body. The blood you push through the patient’s body will carry some oxygen to important organs. Your
willingness to respond may increase the patient’s chance for survival until EMS personnel arrive.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
Key Points
¨ CPR is a two-step process. Step one – chest compressions is followed by step two – rescue
breathing. During this skill, you’ll learn step one.
¨ If you are unable or feel uncomfortable giving a patient the rescue breaths – relax. Give the
patient immediate and continuous chest compressions. Chest compressions alone are very
beneficial to an unresponsive patient who is not breathing normally. Your efforts will still
help circulate blood that contains oxygen.
3-17
Primary and Secondary Care Instructor Guide
¨ Use the Cycle of Care and AB-CABS memory word to help you remember to perform Chest
Compressions before opening a patient’s Airway and Breathing for the patient.
¨ Give the Responder Statement and tap the patient on the collarbone. If the patient is
unresponsive, quickly check for an open airway and normal breathing.
¨ If the patient is not breathing normally, immediately begin Chest Compressions.
¨ The patient must be on his back and on a sturdy surface prior to beginning chest
compressions.
¨ Only practice CPR – chest compressions on a mannequin, never on another participant.
INSTRUCTOR NOTE – In the first few minutes after cardiac arrest, a patient may be
barely breathing, or taking infrequent, noisy, gasps. This is often termed agonal
breathing and must not be confused with normal breathing.
3. Alert EMS if the patient is unresponsive and not breathing normally. CALL FIRST before
providing care.
¨ Ask a bystander to call EMS and secure an AED if possible.
¨ If you are alone, use your mobile phone to call EMS.
¨ Leave the patient to call EMS if no other option exists.
4. Position patient on his back (if not already in this position).
5. Locate the chest compression site.
¨ Expose the patient’s chest only if necessary to find the
compression site.
¨ Find the compression site by putting the heel of one
hand in the chest center. On some individuals, this
position is between the nipples.
¨ Place your other hand on top of the hand already on the
chest and interlock your fingers.
¨ Use the palm of your hand on the compression site. Keep fingers off the chest.
3-18
Section Three – Skill Development
INSTRUCTOR NOTE – Over the years, one strategy for helping participants
remember the approximate rate of chest compressions is to push on a patient’s
chest to the fast rhythm of a disco tune, like the song “Staying Alive.”
Skill Practice
In their practice groups, have participants perform CPR – chest compressions on a mannequin. One
person is the guide, reading the steps, one watches, while the other is the Emergency Responder.
Walk the participants through the numbered steps slowly to make sure their hand, arm and body
position is appropriate. Next, have participants practice the steps again in real-time. If groups must
take turns with mannequins, have those waiting practice their hand arm and body position on another
participant lying down on his back (remind participants not to actually perform compressions). Allow
participants to practice at their own speed.
Debrief
Conclude with a role-model, real-time demonstration of Chest Compressions using a mannequin.
Allow for additional practice as necessary to increase participant competence and confidence. Remind
participants that they cannot make a patient worse by administering CPR – the patient already lacks a
heartbeat. Remind participants that adequate care provided is better than perfect care withheld.
3-19
Primary and Secondary Care Instructor Guide
Performance Requirements
Demonstrate how to
¨ Perform adult complete CPR – chest compressions and rescue breathing – at a ratio of 30
chest compressions to 2 rescue breaths.
¨ Minimize interruptions in chest compressions.
Value
Chest compressions alone are very beneficial to a patient who is unresponsive and not breathing
normally. However, if you are also willing to provide rescue breaths to a patient in need, you may
further increase the patient’s chance for survival until EMS personnel arrive. After completing
this skill you should trust your training and provide an unresponsive patient who is not breathing
normally with complete CPR – Chest Compressions and Rescue Breathing.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
Key Points
¨ Use the Cycle of Care and AB-CABS memory word to help you remember to perform Chest
Compressions before opening a patient’s Airway and Breathing for the patient.
¨ Give the Responder Statement and tap the patient on the collarbone. If the patient is
unresponsive, quickly check for an open airway and normal breathing. If the patient is not
breathing normally, immediately begin Chest Compressions.
3-20
Section Three – Skill Development
1. Assess the scene for safety. Check the patient for responsiveness by giving the Responder
Statement: Hello? My Name is_____________________. I’m an Emergency Responder. May
I help you? If no response to your statement, then tap the patient on collarbone and ask,
Are you okay? Are you okay? The collarbone is sensitive and tapping it will reveal a level of
responsiveness.
2. After delivering the Responder Statement, quickly check for an open Airway and normal
Breathing.
3. If the patient is not responsive or breathing normally, ask a bystander to call EMS and bring an
AED if one is available. If you are alone, use your mobile phone to call EMS. If you do not have
a mobile phone, leave the patient to call EMS if no other option exists. This is the Call First
approach to emergency care. You Call First to activate EMS, then you provide assistance.
4. Position patient on his back (if not already in this position).
5. Locate the chest compression site.
¨ Expose the patient’s chest only if necessary to find the compression site.
¨ Find the compression site by putting the heel of one hand in the chest center. On some
individuals, this position is between the nipples.
¨ Place your other hand on top of the hand already on the chest and interlock your fingers.
¨ Use the palm of your hand on the compression site. Keep fingers off the chest.
3-21
Primary and Secondary Care Instructor Guide
3-22
Section Three – Skill Development
INSTRUCTOR NOTE – If patient has an injury to the face or jaw, gently close the
mouth to protect the injured site. While holding the jaw closed, place your mouth
over the barrier covering the nose and give rescue breaths through the nose.
Certain ventilation barriers (such as a ventilation mask) are better for mouth-to-
nose than others. Using a ventilation mask is another form of rescue breathing
called mouth-to-mask.
9. With the patient’s head tilted back and the ventilation barrier in
place, pinch the nose closed.
10. Now, give two rescue breaths. Each breath should last about 1
second. Provide the patient with just enough air to make the
patient’s chest rise. Look for this rise in the patient’s chest.
¨ If you can’t make the patient’s chest rise with the first breath,
repeat the head tilt-chin lift or pistol grip lift to re-open the
airway before attempting another breath. Improperly opening
a patient’s airway is the most common cause for not being able to
inflate a patient’s lungs.
INSTRUCTOR NOTE – Do not try more than twice to give rescue breaths that make
the chest rise. Minimize delay between chest compressions. After two breaths, whether
they make the chest rise or not, begin chest compressions again.
11. After delivering two rescue breaths, immediately begin another cycle of 30 chest compressions.
Minimize delays in providing chest compressions.
12. Continue alternating 30 compressions with two breaths until:
¨ EMS arrives.
¨ You can defibrillate with an AED (Automated External Defibrillator).
¨ The patient becomes responsive and begins to breath normally.
¨ Another Emergency Responder takes over CPR efforts.
¨ You are too exhausted to continue.
3-23
Primary and Secondary Care Instructor Guide
Skill Practice
In their practice groups, have participants perform CPR – chest compressions combined with rescue
breathing on a mannequin. One person is the guide, reading the steps, one watches, while the other
is the Emergency Responder. Walk the participants through the numbered steps slowly to make
sure their hand, arm, and body position is appropriate. Also, make sure each participant masters the
head tilt-chin lift to effectively open an airway allowing them to deliver rescue breaths. Next, have
participants practice the steps again in real-time. If groups must take turns with mannequins, have
those waiting practice their hand arm and body position on another participant lying down on his back
(remind participants not to actually perform compressions). Allow participants to practice at their own
speed.
Debrief
Conclude with a role-model, real-time demonstration of Chest Compressions combined with
Rescue Breaths using a mannequin. Allow for additional practice as necessary to increase participant
competence and confidence. Remind participants to relax if they feel uncomfortable giving a non-
breathing patient rescue breaths. Encourage these participants to give the patient continuous chest
compressions. Chest compressions alone are very beneficial to a patient without a heartbeat. Remind
them that their efforts may still help circulate blood that contains some oxygen. Adequate care
provided is better than perfect care withheld.
3-24
Section Three – Skill Development
Value
CPR followed by early defibrillation with an AED is key to reviving a patient suffering from a
cardiac emergency involving ventricular fibrillation.
Cycle of Care: AB-CABS™
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
Key Points
¨ An AED is a sophisticated, battery-powered, microprocessor-based device that incorporates a
heart rhythm analysis and a shock-advisory system. AEDs are designed for lay rescuers like you.
¨ The AED connects to the patient via two chest pads. It analyzes a patient’s heart rhythm
automatically and detects when a shock is needed to restore a normal heart rhythm.
¨ In some regions, AED use by laypersons may be restricted.
¨ Remember to stop, think, then act – assess scene and alert EMS. When obtaining help, ask
someone to call EMS and to bring an AED, if one is available.
¨ Protect yourself and patient from disease transmission by using gloves and ventilation
barriers if available. Do not delay emergency care if barriers are not available.
¨ Perform a patient responsiveness check by giving the Responder Statement and then if
unresponsive, tapping the collarbone.
¨ Perform a primary assessment and use the Cycle of Care to continually monitor a patient’s
medical status.
¨ CPR should always be performed while an AED is located and readied for use - even if the
AED is immediately available.
3-25
Primary and Secondary Care Instructor Guide
Critical Steps
INSTRUCTOR NOTE – The following steps are generic and
universal. Please refer to the manufacturer guidelines and
instructions for use when demonstrating a specific AED.
3-26
Section Three – Skill Development
¨ One pad goes on the upper-right side of the chest, below the collarbone and next to the
breastbone.
¨ One pad goes on the lower-left side of the chest, to the left and below the nipple line.
8. Plug in AED if needed or prompted. AED will analyze the
patient’s heart rhythm. (Some AEDs require you to push
an Analyze button.)
9. Clear rescuers and bystanders from the patient making
sure no one is touching the patient. Also, make sure no
equipment is touching the patient. Say, I’m clear, you are
clear, everyone is clear.
10. If the AED advises that a shock is needed, the responder
should follow the prompts to provide one shock, followed
by CPR. If the AED does not advise a shock, immediately
resume CPR.
11. The AED will again analyze the patient’s heart rhythm. If
normal breathing is still absent, the AED may prompt you to deliver another shock. Most
AEDs will wait two minutes before analyzing and shocking the patient again. Between that
time, continue CPR.
12. As prompted, continue to give single shocks combined with CPR until the patient resumes
breathing, until relieved by EMS personnel, or until you are physically unable to continue.
13. If the patient begins breathing normally, support the open airway and continue to use the
Cycle of Care to monitor the patient’s medical status.
Skill Practice
In practice groups using the Emergency First Response Participant Manual, have participants practice
using an AED on a mannequin. Have participants follow the protocol listed unless the specific
machine you are using in class has differing guidelines. Always follow the manufacturer’s guidelines.
If participants must share mannequins and AEDs, allow plenty of time
for skill development.
Debrief
Allow for additional practice as necessary to increase participant
competence and confidence. Provide them with the following AED
precautions:
¨ Do not attach an AED to a responsive person.
¨ Do not use an AED on a patient with a medication patch on the
chest. Remove the patch and clean the skin prior
to AED pad placement.
¨ Avoid analyzing patient or defibrillating a
patient with an AED while in a moving vehicle.
The movement may cause the AED to indicate a
shock is needed when it is not. Stop the vehicle
and allow the AED to analyze the patient.
¨ Avoid the use of cell phones or radio equipment
around AEDs.
3-27
Primary and Secondary Care Instructor Guide
Value
Loss of blood and fluids from the patient’s body may be life-
threatening. By controlling serious bleeding, you can maintain the
body’s vital blood supply.
Key Points
¨ Remember to stop, think, then act – assess scene and alert EMS.
¨ Use barriers appropriately. For serious bleeding, appropriate barriers include gloves, eye
shield, and personal facemask. Protect yourself and patient from disease transmission by
using gloves and barriers.
¨ Perform a patient responsiveness check by giving the Responder Statement and then if
unresponsive, tapping the collarbone.
¨ Perform a primary assessment – remember bleeding must be severe to be life-threatening.
Use the Cycle of Care to continually monitor a patient’s medical status.
¨ Reassure the patient as you treat for bleeding.
¨ Assist patient into a position of comfort while treating.
¨ Keep in mind that direct pressure is the first and most successful method for serious bleeding
management.
¨ Using a pressure bandage is the next step to control bleeding. A pressure bandage is anything
that places constant direct pressure on a wound.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
Serious Bleeding
Management
B Breathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
3-28
Section Three – Skill Development
Critical Steps
Direct Pressure
1. Give Emergency Responder Statement. Assess scene,
alert EMS and make sure airway is open.
2. Put on barriers – gloves, eye shields, and facemask as
appropriate.
3. Place a clean cloth or sterile dressing over the wound
and apply sustained direct pressure. If a dressing or
cloth is not available, use gloved hand.
4. Release pressure periodically to determine if bleeding has slowed or stopped.
Pressure Bandage
1. While applying sustained direct pressure on the wound, apply another bandage over the
sterile dressing.
2. If the bandage becomes blood soaked, place another clean cloth or dressing on top and
bandage in place.
3. Continue to apply sustained direct pressure to the wound to assist in bleeding control.
4. Don’t remove blood-soaked bandages because blood clots in the dressing help control
bleeding. Add bandages as necessary. (There may be country specific protocols for when to
remove bandages.)
5. Bandage rather tightly – avoiding total restriction of blood flow (no discoloring of fingers or
toes). Keep the pressure bandage flat against wound – avoid allowing the bandage to twist
into a small string.
Skill Practice
In practice groups using the Emergency First Response Participant Manual, have participants begin with
primary assessment and attend to a serious bleeding wound on a patient’s arm. They should progress
from direct pressure to a pressure bandage.
Debrief
Allow for additional practice as necessary to increase participant competence and confidence.
3-29
Primary and Secondary Care Instructor Guide
Shock Management
Performance Requirement
Demonstrate how to manage shock by conducting a primary assessment, protecting the patient
and stabilizing the head.
Value
Shock is a result of circulatory system failure. Therefore, it can be life-threatening and a factor in
almost every injury or illness. By recognizing and treating shock, you prevent further disability.
Key Points
¨ Remember to stop, think, then act – assess scene and alert EMS.
¨ Protect yourself and patient from disease transmission by using gloves and barriers if
available. Do not delay emergency care if barriers are not available.
¨ Perform a patient responsiveness check by giving the Responder Statement and then if
unresponsive, tapping the collarbone.
¨ Perform a primary assessment and use the Cycle of Care to continually monitor a patient’s
medical status.
Cycle of Care: AB-CABS™
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
Shock
B Breathing
for Patient
Management
S SS erious Bleeding
hock
Spinal Injury
¨ Shock results when an injury or illness makes it difficult for the body’s cardiovascular system
to provide adequate amounts of oxygenated blood to vital organs.
¨ Always treat an injured or ill patient for shock even if signs and symptoms are absent.
¨ For a responsive patient, let the patient determine what position is most comfortable –
sitting, lying down, etc. Unresponsive patients could be placed in the Recovery Position.
3-30
Section Three – Skill Development
Critical Steps
1. Treat an injured, unresponsive or unconscious patient in the position found. Do not move
if possible.
2. Hold the patient’s head to keep the neck from moving.
3. Maintain patient’s body temperature based on local climate. This may mean covering the
patient with a blanket or exposure protection from the sun.
4. If there are no spinal injuries or leg
fractures suspected, elevate the legs 15-30
centimetres/6-12 inches to allow blood to
return to the heart.
Skill Practice
In practice groups using the Emergency First
Response Participant Manual, have participants begin
with primary assessment and manage shock for
an unconscious patient. Have blankets or towels
available. Encourage participants to be resourceful
and use what is available around them. Use of
barriers is optional for skill practice.
Debrief
Allow for additional practice as necessary to increase
participant competence and confidence.
3-31
Primary and Secondary Care Instructor Guide
Value
Many accidents result in some form of trauma to the head, neck and back. By providing the proper
emergency care, you can prevent further injury to the patient.
Key Points
¨ Remember to stop, think, then act – assess scene and alert EMS.
¨ Protect yourself and patient from disease transmission by using gloves and barriers if
available. Do not delay emergency care if barriers are not available.
¨ Perform a patient responsiveness check by giving the Responder Statement and then if
unresponsive, tapping the collarbone.
¨ Suspect a spinal injury for any incident involving a fall, severe blow, crash or other strong
impact. Also suspect spinal injury if a patient complains of back or neck pain or can’t move
an arm or leg.
¨ If possible, perform primary assessment in the position the patient is found. Do not move
patient unless safety is in question. Use the Cycle of Care to continually monitor a patient’s
medical status.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
Spinal Injury
B Breathing
for Patient Management
S SS erious Bleeding
hock
Spinal Injury
Critical Steps
For a responsive patient who is breathing normally:
1. Stabilize the head by placing a hand on each side to prevent movement. Attempt to anchor
your arms or elbows on the ground or use a similar stable position to assist with minimizing
your hand movement.
2. Instruct the patient to remain still and not move his head or neck while you wait for EMS
to arrive.
3-32
Section Three – Skill Development
Skill Practice
In practice groups using the Emergency First Response Participant Manual, have participants perform
primary assessment on a responsive patient with a suspected spinal injury. Then have participants practice a
log roll and primary assessment on an unconscious patient with a suspected spinal injury who is positioned
face down. If practical, have participants practice both two-person and one-person log rolls. Use of barriers
optional for skill practice.
Debrief
Conclude with a role-model, real-time demonstration of a log roll and primary assessment on an
unconscious patient. Allow for additional practice as necessary to increase participant competence
and confidence.
3-33
Primary and Secondary Care Instructor Guide
Performance Requirement
Demonstrate how to assist a conscious and unconscious choking patient with a partial or
complete (severe) airway obstruction.
Value
Choking is a life-threatening condition that needs immediate resolution. By following a simple
procedure, you may be able to assist a choking patient in expelling an obstruction.
Key Points
¨ Remember to stop, think, and then act.
¨ If the patient is coughing, wheezing or can speak, observe until the patient expels the
obstruction. Reassure and encourage the patient to keep coughing to expel the foreign
material.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
¨ Remember that a conscious adult must give consent before you do anything. A head nod is
sufficient.
¨ If the blockage is severe, the patient will not be able to cough.
¨ Perform chest thrusts on pregnant or obese individuals rather than abdominal thrust.
¨ Patients who receive the treatment for conscious choking should be medically evaluated to
rule out any life-threatening complications.
3-34
Section Three – Skill Development
3-36
Section Three – Skill Development
3-37
Primary and Secondary Care Instructor Guide
Skill Practice
In practice groups using the Emergency First Response Participant Manual, have participants assist
a conscious choking adult. Caution participants not to actually perform thrusts on non-choking
participants for practice. Use of barriers is optional for skill practice. Discuss and/or have participants
perform the steps for assisting a patient who has become unconscious from a choking incident.
Debrief
Conclude with a role-model, real-time demonstration on a choking adult. Again, caution participants
not to actually perform thrusts for practice. Allow for additional practice as necessary to increase
participant competence and confidence.
3-38
Section Three – Skill Development
Value
Receiving adequate oxygen is crucial, especially after a serious injury, illness, near-drowning incidents
or altitude respiratory problems. You can decrease patient stress and support the respiratory system
by administering emergency oxygen.
Key Points
¨ Remember to stop, think, then act – assess scene and alert EMS.
¨ Protect yourself and patient from disease transmission by using gloves and barriers if available.
Do not delay emergency care if barriers are not available.
¨ Perform a patient responsiveness check by giving the Responder Statement and then if
unresponsive, tapping the collarbone. Before placing the oxygen mask on a responsive patient
say, This is oxygen, may I place this mask on you?.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
¨ Perform a primary assessment and use the Cycle of Care to continually monitor a patient’s
medical status.
¨ Become familiar with emergency oxygen units before you need to use them – at home, work,
school, etc.
¨ Use emergency oxygen in a ventilated area away from any source of flame or heat.
¨ Handle oxygen cylinder carefully because contents are under high pressure. Avoid dropping
cylinder or exposing it to heat.
¨ In some regions, oxygen use is restricted.
3-39
Primary and Secondary Care Instructor Guide
Critical Steps
INSTRUCTOR NOTE – Demonstrate oxygen unit set up for participants. Participants
do not need to become proficient at setting up the unit they use for skill practice.
Skill Practice
In practice groups using the Emergency First Response Participant Manual, set up an oxygen unit. Have
participants perform a primary assessment on a responsive patient, and offer a patient emergency
oxygen. Use of barriers optional for skill practice.
Debrief
Allow for additional practice as necessary to increase participant competence and confidence You
may want to seek additional and more advanced oxygen training if you are a scuba diver or frequent
locations with aquatic activities.
3-40
Section Three – Skill Development
Skill Development
Secondary Care (First Aid)
Introduction
This segment covers the four required skills for the Secondary Care (First Aid) course. Secondary
Care (First Aid) teaches Emergency Responders what to do beyond primary care when Emergency
Medical Services (EMS) are either delayed or unavailable.
You’ll find information about each skill and step-by-step directions for organizing skill development.
Listed for each skill are the performance requirement(s), a value statement, key points, critical steps
and suggestions for conducting skill practice.
During skill development, the amount of information you deliver and the required detail of your
demonstration depends on the instructional delivery approach you follow — independent study,
video guided or Instructor Led. Refer to the “How to Use This Guide” at the beginning of Section
Three for special directions regarding instructional delivery approach.
Similar to the Primary Care (CPR) course, you introduce
each skill by reviewing the performance requirement,
value and key points. Next, you provide a demonstration
using the critical steps. After dividing participants into
practice groups, you monitor practice, provide positive
reinforcement and offer suggestions for improved
technique. Allow for additional practice as necessary to
increase participant competence and confidence.
Because you may have several practice groups
working on skills at the same time, make sure you
can adequately supervise development, answer
questions and advise participants. Remember to keep
answers to questions brief and to the point, and to
answer situational or “what-if ” questions by sending
participants back through the Cycle of Care.
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Primary and Secondary Care Instructor Guide
Injury Assessment
Performance Requirement
Demonstrate how to conduct a head-to-toe injury assessment on a patient and note injuries to
report to Emergency Medical Service (EMS) personnel.
Value
A head-to-toe injury assessment helps you recognize, attend to and report both external and internal
injuries that may affect a patient’s condition.
Key Points
¨ Use this skill to determine what first aid may be needed in the event of any injury – especially
when EMS is either delayed or unavailable.
¨ Remember to stop, think, then act – assess scene and alert EMS.
¨ Protect yourself and patient from disease transmission by using gloves and barriers if
available. Do not delay emergency care if barriers are not available.
¨ Perform a patient responsiveness check by giving the Responder Statement and then if
unresponsive, tapping the collarbone.
¨ Perform a primary assessment and use the Cycle of Care to continually monitor a patient’s
medical status.
¨ Only perform injury assessments on conscious, responsive patients.
¨ When possible, perform the assessment in the position the patient is found.
¨ If wound dressings are in place, do not remove during the assessment.
¨ Look for wounds, bleeding, discolorations or deformities.
¨ Listen for unusual breathing sounds.
¨ Feel for swelling or hardness, tissue softness, unusual masses, joint tenderness, deformities,
moisture and changes in body temperature. Make mental notes of the assessment and report
findings to EMS personnel.
¨ Avoid giving injured patient anything to eat or drink, as he may need surgery.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
3-42
Section Three – Skill Development
Critical Steps
1. Deliver the Responder Statement, asking permission to assist.
Explain what you’ll be doing during the assessment. Put on gloves if
available.
2. Stabilize the patient’s head and neck and instruct the patient to
answer verbally. Do not allow the patient to move or nod his head. 1
3. Immediately stop the assessment if the patient complains of head,
neck or back pain. Continue to stabilize the head and neck, end your
assessment and wait for EMS to arrive. Do not move patient.
4. Start assessment at the head and work your way down the body to
the toes.
3
5. Feel for deformities on the patient’s face by gently running your
fingers over the forehead, cheeks and chin.
6. Check the ears and nose for blood or fluid. If present, suspect head
injury and stop further assessment.
7. Place a finger in front of the patient’s eyes. Without moving the
head, have the patient follow your finger with his eyes. Check the
eyes for smooth tracking. The eyes should move together. If possible,
5
check pupil size and reaction to light.
8. Feel the skull and neck for abnormalities. If the patient complains of
pain, stop the assessment.
9. If you can reach the shoulder blades, slide or place one hand over
each shoulder blade and gently push inwards.
7
10. Move hands outward to the shoulders and press gently inward with
the palm.
11. Run two fingers over the collarbones from the shoulders to the
center.
12. Place one hand on the shoulder to stabilize the arm and gently slide
the other hand down the upper arm, elbow and wrist. Repeat on
the other arm. Ask the patient to wiggle fingers on both hands and
9
squeeze your hands.
13. Inspect chest for deformity. Place a hand, palm in, on each side of
the patient’s rib cage and gently push inward.
14. Gently put your hands under patient to feel the spinal column.
Cover as much area as possible without moving the patient. Gently
touch along the patient’s spine, feeling for abnormalities. 10
15. Using one hand, gently push on the patient’s abdomen. Apply gentle
pressure to the right and left side abdomen, and above and below the
navel (belly button).
16. Move hands gently over the hipbones to check for swelling or
hardness, tissue softness, unusual masses, joint tenderness, and
deformities. Avoid pushing inward on hips. 12
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Primary and Secondary Care Instructor Guide
17. Starting at the thigh, slide your hand down the upper leg, knee,
lower leg and ankle as you did with the arm. Ask the patient
to wiggle toes and press the sole of the foot against your hand.
Repeat on the other leg.
18. Note areas of pain or abnormality for your report to EMS
personnel. Continue to monitor the patient by using the Cycle 17
of Care.
Skill Practice
Using the injury assessment steps (in either Emergency First Response Participant Manual or this
guide), have participants conduct an injury assessment. Have each patient think of an imaginary
injury. The patient should not share this imaginary injury with the Emergency Responder. It is the
Emergency Responder’s job to discover the injury. The patient acts out the injury.
Debrief
Conclude with a role-model, real-time demonstration. Allow for additional practice as necessary to
increase participant competence and confidence.
3-44
Section Three – Skill Development
Illness Assessment
Performance Requirements
Demonstrate how to conduct an illness assessment by:
¨ Asking how a patient feels and obtaining information about a patient’s medical history.
¨ Checking a patient’s respirations, pulse rate, temperature, skin moisture and color.
¨ Reporting findings to Emergency Medical Service personnel.
Value
An illness assessment helps you identify and report medical problems that affect a patient’s health
and may aid in the patient’s treatment.
Key Points
¨ Use this skill to determine what first aid may be needed in the event of any illness –
especially when EMS is either delayed or unavailable.
¨ Remember to stop, think, then act – assess scene and alert EMS if necessary.
¨ Protect yourself and patient from disease transmission by using gloves and barriers if
available. Do not delay emergency care if barriers are not available.
¨ Perform a patient responsiveness check by giving the Responder Statement and if
unresponsive, tapping the collarbone.
¨ Perform a primary assessment and use the Cycle of Care to continually monitor a patient’s
medical status.
¨ Only perform illness assessments on conscious, responsive patients.
¨ When giving information to EMS personnel, avoid using the word normal. Provide measured
rates per minute and descriptive terminology.
¨ Use the mnemonic SAMPLE to remember how to conduct an illness assessment. SAMPLE
stands for Signs and Symptoms, Allergies, Medications, Preexisting medical history, Last
meal and Events.
¨ Signs are something you see is wrong with a patient. Symptoms are something the patient
tells you is wrong.
¨ To help guide your assessment, remember that:
• The average breathing rate for adults is between 12 and 20 breaths per minute. A patient
who takes less than eight breaths per minute, or more than 24 breaths per minute, probably
needs immediate medical care.
• The average pulse rate for adults is between 60 and 80 beats per minute.
• Average skin temperature is warm and skin should feel dry to the touch.
• Noticeable skin color changes may indicate heart, lung or circulation problems.
• By conducting an illness assessment on a healthy person in class, you will be able to
recognize differences later when you assist an unhealthy person.
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Primary and Secondary Care Instructor Guide
¨ If a patient complains of chest discomfort or pain call EMS immediately and encourage
patient to:
• Take any prescribed medication for such discomfort, or
• Chew 1 adult, non-coated aspirin (unless patient has an allergy or other contraindication
to aspirin).
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
Critical Steps
1. Find a paper and a pen/pencil to record illness assessment information. Use the Illness and
Injury Assessment Record sheet in the participant manual (This Assessment Record Sheet can
also be found in the Appendix of this guide. Photocopy when necessary.)
2. If possible, get someone else to record information while you attend to the patient.
3. Put on gloves when needed.
3-46
Section Three – Skill Development
X Never try to feel the carotid pulse on both sides at the same time.
X Count the number of beats in 30 seconds and multiply by two to determine the heartbeats
per minute.
3. To find pulse rate using the radial artery:
X Locate artery on patient’s wrist, thumb side of hand.
X Slide two or three fingers into the groove of the wrist immediately below hand on the thumb
side.
X Do not use your thumb when taking a radial pulse.
X Count the number of beats in 30 seconds and multiply by two to determine the heartbeats
per minute.
4. Determine whether the pulse may be described as rapid, strong or weak.
Checking Respiration
5. Look for signs and symptoms of respiratory distress, including:
X Wheezing, gurgling or high-pitched noises when the patient breathes.
X Patient complains of shortness of breath or feeling dizzy or lightheaded.
X Patient complains of pain in the chest and numbness or tingling in arms or legs.
6. To count the number of times a patient breathes, use one of two methods:
X First method: Simply watch patient’s chest rise and fall and count respirations.
X Second method: If you cannot see the patient’s chest rise and fall, place a hand on the
patient’s abdomen. This position allows you to mask your efforts to obtain a count of the
patient’s respirations. Patients often alter their breathing rate if they become aware their
breaths are being counted.
For both methods, count patient’s respirations for 30 seconds and multiply by two to
determine respiratory rate.
7. Determine whether respirations may be described as fast, slow, labored, wheezing or gasping.
3-47
Primary and Secondary Care Instructor Guide
Determining Color
10. Look for apparent skin color changes that may be described as extremely pale, ashen (grey),
red, blue, yellowish or black-and-blue blotches.
11. If the patient has dark skin, check for color changes on the nail beds, lips, gums, tongue,
palms, whites of the eye and ear lobes.
SAMPLE – Allergies
1. Ask if patient is allergic to anything – food, drugs, airborne matter, etc.
2. Has the patient ingested or taken anything he may be allergic to? Has the patient been bitten
or stung by an organism?
3. Treat severe allergic reactions as a medical emergency and follow primary care procedures.
4. A severe allergic reaction (anaphylaxis) can be treated by epinephrine. People who have
suffered a prior episode of anaphylaxis often have prescribed an auto-injector of epinephrine.
Have the patient use the auto-injector or assist them with its use.
5. In unusual circumstances when advanced medical assistance is not available, a second dose of
epinephrine may be given if symptoms of anaphylaxis persist.
SAMPLE – Medications
1. Ask if patient takes medication for a medical condition. Questions may include:
X Do you take medication?
X If yes, what type of medication do you take?
X Did you take medication today?
X How much medication did you take and when?
2. If possible, collect all medication to give to EMS personnel and/or get name of the doctor
who prescribed the medication.
SAMPLE – Events
1. Ask patient about or note events leading up to illness.
Skill Practice
Using the Illness Assessment Record sheet, either in the Emergency First Response Participant Manual
(Reference Section) or the Appendix of this guide, have participants begin with primary assessment
and work through illness assessment in practice groups. By having participants conduct an illness
assessment on a healthy person in class, they will be able to recognize differences later when they
assist an unhealthy person.
Debrief
Allow for additional practice as necessary to increase participant competence and confidence.
3-48
Section Three – Skill Development
Bandaging
Performance Requirement
Demonstrate how to bandage a foot, leg, hand or arm using roller bandages and triangular
bandages.
Value
A properly applied bandage can apply direct pressure to a wound and hold dressing in place to
control bleeding. It can also prevent or reduce swelling, and provide support for an extremity or joint.
Key Points
¨ Use this skill in the event of any injury – especially if EMS is either delayed or unavailable.
¨ Remember to stop, think, then act – assess scene and alert EMS if necessary.
¨ Protect yourself and your patient from disease transmission by using barriers if available. Do not
delay emergency care if barriers are not available.
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
¨ Perform a patient responsiveness check by giving the Responder Statement and then if
unresponsive, tapping the collarbone.
¨ Perform a primary assessment and use the Cycle of Care to continually monitor a patient’s
medical status.
¨ Perform an injury assessment.
¨ A first aid kit may include several different types of bandages including triangular bandages,
adhesive strips, conforming bandages, gauze rollers (nonelastic cotton) and elastic rollers.
¨ Choose the best bandage based on the injury or make the best use of whatever is available.
3-49
Primary and Secondary Care Instructor Guide
Critical Steps
Using Roller Bandages
1. Put on gloves if available.
2. Apply the bandage directly over a sterile dressing covering the
wound.
3. Apply the bandage below the wound and work toward the heart.
4. Wrap roller bandage firmly and consistently, but avoid making a
bandage too loose or too tight.
5. Secure the end of the bandage by tying, tucking or taping it in
place.
6. When bandaging the foot, secure the bandage by wrapping it
around the ankle several times then back over the injury site on
the foot.
7. When bandaging the hand, secure the bandage by wrapping it
over the thumb and around the wrist.
8. If the elbow is involved, bandage below and above the joint to
stabilize the injury site.
9. If the knee is involved, bandage below and above the joint to
stabilize the injury.
10. If there is an impaled object, bandage the object in place and do
not remove.
3-50
Section Three – Skill Development
Skill Practice
In practice groups using Emergency First Response Participant Manual,
have participants bandage a leg or arm wound using a roller bandage,
then use a triangular bandage to make an arm sling. Encourage
participants to vary wound sites.
Debrief
Allow for additional practice as necessary to increase participant competence and confidence.
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Primary and Secondary Care Instructor Guide
Value
Splinting may prevent further injury, lessen pain, and reduce the risk of serious bleeding if EMS is
delayed or it is necessary to transport the patient to a medical facility.
Key Points
¨ Use this skill in the event of any injury – especially if EMS is either delayed or unavailable.
¨ Remember to stop, think, then act – assess scene and alert EMS if necessary.
¨ Protect yourself and your patient from disease transmission by using barriers if available. Do not
delay emergency care if barriers are not available.
¨ Perform a patient responsiveness check by giving the Responder Statement and then if
unresponsive, tapping the shoulder or arm.
¨ Perform a primary assessment and use the Cycle of Care to continually monitor a patient’s
medical status.
¨ Perform an injury assessment.
¨ Use splinting to protect and immobilize a fractured, dislocated, sprained or strained body part.
¨ Splints may include a variety of rigid devices including commercial splints, improvised splints
(rolled newspapers or magazines, heavy cardboard, padded board, etc.) or securing the injured
part to an uninjured body part (e.g., injured finger to an uninjured finger; injured arm to the
chest, etc.)
Cycle of Care: AB-CABS™
AB C
Chest
Airway Breathing
Open? Normally?
Compressions
AA irway Open
BB reathing
for Patient
S SS erious Bleeding
hock
Spinal Injury
¨ Splint the injury in the position found. Do not try to straighten. Try to minimize movement
of the extremity until you complete splinting.
¨ If available, place splint materials on both sides of the injury site. This prevents rotation of the
injured extremity and prevents the bones from touching if two or more bones are involved.
¨ Splint only if you can do so without causing more discomfort and pain to the patient.
3-52
Section Three – Skill Development
Critical Steps
1. Choose a splint long enough to immobilize joints above and below
the injury.
2. When using rigid splints, apply ample padding between the splint
and the injury. Add padding to the natural body hollows as well.
3. Bandage the splint in place by using a roller bandage, a triangular
bandage, an elastic bandage, adhesive tape or other available
materials.
4. Always check circulation before and after splinting. If pulse is
absent, loosen the splint until the pulse returns. To do this, look for
color of tissue in fingernails and toenails.
5. If the fracture is in the upper arm, place arm in sling after splinting.
Skill Practice
In practice groups using Emergency First Response Participant Manual,
have participants splint a leg or arm. Have a variety of splinting material
available. Encourage participants to be resourceful and use what they find
around them. Have participants vary splinting sites. Use of barriers optional
for skill practice.
Debrief
Allow for additional practice as necessary to increase participant
competence and confidence. Consider performing a role-model, real-time
injury assessment together with splinting an injury site.
3-53
Primary and Secondary Care Instructor Guide
3-54
Section Four – Scenario Practice
Four
Scenario Practice
Introduction
Emergency scenario practice allows participants to apply the skills they develop to realistic
situations. Each scenario requires participants to evaluate the scene, recall critical steps, and take
appropriate action. The circumstances vary which lets participants use all their skills to work
through different challenges. Practice begins with simple situations and progresses to multiple injury
accidents. Although the nature and context is serious, the practice should encourage discovery, build
confidence, and be as enjoyable as possible.
Overview
This section includes four primary care scenarios
and one secondary care scenario. Each scenario
prompts participants to use specific skills. You’ll
find two suggested scenes for each scenario – Scene
A and B. You may conduct the scenario using
either of these scenes, or modify the situation to
meet local needs. Listed under each scenario are
factors you may change without altering the intent
of the exercise.
You’ll conduct the scenario practice session using
the same procedures no matter which instructional
delivery approach you use (independent study, video guided or instructor led). For each scenario,
you’ll find a situation overview, performance requirement, procedures, and evaluation questions. Use
these instructions to conduct practice.
4-1
Primary and Secondary Care Instructor Guide
4-2
Section Four – Scenario Practice
Primary Care
Factors you can change – Any room or area of a home. Any adult relative or person who lives in
household.
Performance Requirement
Demonstrate scene assessment and primary assessment procedures for assisting an unconscious,
breathing patient. (Primary Care Skills One – Three)
4-3
Primary and Secondary Care Instructor Guide
Procedures
1. Review the Situation Overview with participants.
2. Break participants into practice groups. Assign roles – patient, Emergency Responder and
guide.
3. Position patient sitting against wall or chair. Have responder approach patient and begin care.
The guide observes and has Emergency First Response Participant Manual available to reference.
4. During scenario, provide direction only as necessary.
5. Stop scenario when Emergency Responder has completed primary assessment and is waiting
for EMS to arrive.
6. Repeat scenario as necessary to allow all participants to act as Emergency Responder.
Consider changing factors to keep it interesting and stimulate further learning.
7. Conclude scenario practice and encourage discussion by asking participants the evaluation
questions. Clarify information, techniques and procedures as necessary.
Evaluation Questions
Use the following questions to discuss participant performance:
1. Did Emergency Responder evaluate the scene before attending to patient?
2. Were barriers used? If not, why?
3. When and how was EMS called?
4. Was primary assessment performed effectively and the patient’s airway managed?
5. Did Emergency Responder move or reposition patient? Why? How?
6. Did Emergency Responder use the Cycle of Care to continually monitor a patient’s medical
status?
4-4
Section Four – Scenario Practice
Primary Care
Factors you can change – Any public area and any adult patient.
Performance Requirement
Demonstrate scene assessment, barrier use, primary assessment and one rescuer CPR for
assisting patient that is unresponsive and not breathing normally. Primary Care Skills One –
Five; including the Optional AED skill if learned by participants.
4-5
Primary and Secondary Care Instructor Guide
Procedures
1. Review the Situation Overview with participants.
2. Break participants into practice groups. Assign roles – patient, Emergency Responder and
guide/bystander.
3. Position patient on side on the floor. Explain that Emergency Responder may ask a
bystander for assistance if necessary – however the bystander is not CPR/first aid trained.
Have responder approach patient and begin care. The guide may reference Emergency First
Response Participant Manual as appropriate.
4. During the scenario, provide direction only as necessary. Use mannequin for CPR practice.
5. Stop scenario when Emergency Responder has completed several rescue breathing/
compression cycles during CPR.
6. Repeat scenario as necessary to allow all participants to act as Emergency Responder.
Consider changing factors to keep it interesting and stimulate further learning.
7. Conclude scenario practice and encourage discussion by asking participants the evaluation
questions. Clarify information, techniques and procedures as necessary.
Evaluation Questions
Use the following questions to discuss participant performance:
1. Did Emergency Responder evaluate the scene before attending to patient?
2. Were barriers used? If not, why?
3. When and how was EMS called?
4. Was primary assessment performed effectively?
5. Did Emergency Responder move or reposition patient? Why? How?
6. Was CPR initiated and performed properly?
7. Did the Emergency Responder use the Cycle of Care to monitor a patients medical status and
treat any problems discovered?
8. Was there an attempt to locate an AED and use it?
4-6
Section Four – Scenario Practice
Primary Care
Factors you can change – Any recreational setting where patient could fall or suffer severe blow. Any
teenager, young adult or adult.
Performance Requirement
Demonstrate primary care skills including bleeding management, shock management and spinal
injury management. Primary Care Skills One – Eight; including the Optional AED skill if
learned by participants.
4-7
Primary and Secondary Care Instructor Guide
Procedures
1. Review the Situation Overview with participants.
2. Break participants into practice groups. Assign roles – patient, Emergency Responder and
guide/bystander.
3. Position patient face down on floor. Explain that Emergency Responder may ask a bystander
for assistance if necessary – however the bystander is not CPR/first aid trained. Have
responder approach patient and begin care. The guide may reference Emergency First Response
Participant Manual as appropriate or available.
4. Remind Emergency Responder that patient shows signs of breathing normally after
initiating CPR. Use mannequin for CPR practice.
5. During scenario, provide direction only as necessary.
6. Stop scenario when Emergency Responder has attended to patient, is using the Cycle of Care,
and is waiting for EMS to arrive.
7. Repeat scenario as necessary to allow all participants to act as Emergency Responder.
Consider changing factors to keep it interesting and stimulate further learning.
8. If appropriate and available, review use of an AED and emergency oxygen as it relates to this
scenario.
9. Conclude scenario practice and encourage discussion by asking participants the evaluation
questions. Clarify information, techniques and procedures as necessary.
Evaluation Questions
Use the following questions to discuss participant performance:
1. Did Emergency Responder evaluate the scene before attending to patient? Was the location
safe?
2. Did Emergency Responder move or reposition patient? Why? How?
3. Were barriers used? If not, why?
4. When and how was EMS called? Was there an attempt to locate an AED?
5. Was primary assessment performed effectively?
6. How was the airway opened?
7. Did Emergency Responder practice proper bleeding management?
8. Was spinal injury management performed? Why? How?
9. Did Emergency Responder use the Cycle of Care and treat any problems discovered?
4-8
Section Four – Scenario Practice
Primary Care
Factors you can change – Any accident that could injure two people. Any adults.
4-9
Primary and Secondary Care Instructor Guide
Performance Requirement
Demonstrate primary care skills by attending to two patients.
(Skills One – Eight Primary Care Skills One – Eight; including Optional AED skill if learned
by participants.)
Procedures
1. Review the Situation Overview with participants.
2. Break participants into practice groups. Use mannequin for nonresponsive patient, if
necessary. Assign other roles – responsive patient, Emergency Responder and guide/
bystander.
3. Position responsive patient in a chair. Position nonresponsive patient or mannequin lying
face up on floor. Explain that Emergency Responder may ask guide/bystander for assistance
if necessary. Have responder approach scene and begin care. The guide should also reference
Emergency First Response Participant Manual as appropriate or available.
4. During scenario, provide direction only as necessary. Use mannequin for CPR practice.
5. Stop scenario when Emergency Responder has completed several rescue breathing/
compression cycles during CPR and is waiting for EMS to arrive.
6. Repeat scenario as necessary to allow all participants to act as Emergency Responder.
Consider changing factors to keep it interesting and stimulate further learning.
7. Conclude scenario practice by asking participants the evaluation questions and clarifying
information, techniques and procedures as necessary. Reinforce that multiple patients mean
that Emergency Responders should use their judgment and training to attend to the most
life-threatening conditions.
Evaluation Questions
Use the following questions to discuss participant performance:
1. Did Emergency Responder evaluate the scene before attending to patient? Was the location
safe?
2. Did Emergency Responder move or reposition one or both patients? Why? How?
3. Were barriers used? If not, why?
4. When and how was EMS called?
5. Was primary assessment performed effectively on both patients?
6. Was CPR initiated and performed properly?
7. Did Emergency Responder practice proper bleeding management?
8. Was spinal injury management performed? Why? How?
9. Did Emergency Responder effectively attend to both patients?
4-10
Section Four – Scenario Practice
Secondary Care
Factors you can change – Any common location or activity where someone could sustain nonlife-
threatening injuries. Any teenager, young adult or adult.
Performance Requirement
Demonstrate primary and secondary care procedures including illness and injury assessment.
4-11
Primary and Secondary Care Instructor Guide
Procedures
1. Review the Situation Overview with participants.
2. Break participants into practice groups. Assign roles – patient, Emergency Responder and
guide.
3. Confidentially to patient, assign two injuries – one obvious based on the situation and one
less obvious (e.g., Scene A – injured ankle and tender shoulder, Scene B – injured elbow and
tender hip).
4. Position patient sitting against wall or chair, or lying on ground. Have responder approach
patient and begin care. The guide observes and has Emergency First Response Participant
Manual available to reference.
5. During scenario, provide direction only as necessary.
6. Stop scenario when Emergency Responder has completed injury and/or illness assessment.
7. Repeat scenario as necessary to allow all participants to act as Emergency Responder.
Change injury locations or scenarios, as appropriate, to give each participant a chance to
discover unknown injuries/illnesses.
8. Conclude scenario practice and encourage discussion by asking participants the evaluation
questions clarifying information, techniques and procedures as necessary.
Evaluation Questions
Use the following questions to discuss participant performance:
1. Did Emergency Responder evaluate the scene before attending to patient?
2. Were barriers used? If not, why?
3. Was EMS called? If not, why?
4. Was primary assessment performed effectively?
5. Did Emergency Responder move or reposition patient? Why? How?
6. Was injury assessment conducted effectively and were all injuries located?
7. Was patient’s head and neck immobilized during assessment?
8. Did Emergency Responder conduct an illness assessment?
9. Did (or could) the Emergency Responder provide any other care for patient? Bandaging?
Splinting? Shock management?
10. Did Emergency Responder use the Cycle of Care to discover the patient’s medical status and
treat any problems discovered?
4-12
Appendix
Appendix
Contents
Primary Care Knowledge Review Answer Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2
Secondary Care Knowledge Review Answer Key. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3
Primary Care (CPR) Final Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4
Secondary Care (First Aid) Final Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-8
Primary Care (CPR) Final Exam Answer Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-10
Secondary Care (First Aid) Exam Answer Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-11
Primary Care (CPR) Final Exam Answer Key. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-12
Secondary Care (First Aid) Final Exam Answer Key. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-13
EFR Course Registration Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-14
Instructor Skills Completion Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-15
Illness and Injury Assessment Record Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-16
Developing a Marketing Plan – Extending Your Emergency First Response Teaching Opportunities. . A-20
Marketing Presentation – Marketing Emergency First Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-25
Responders In Action Report Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-32
Emergency First Response License Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-33
Bid Proposal Letter (Sample) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-34
Instructor Independent Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-36
Human Body Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-37
Emergency Contact Information Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-44
Independent Learning - Self-Study Instructor Knowledge Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-45
A-1
Primary and Secondary Care Instructor Guide
Participant Manual
Primary Care Knowledge Review Answer Key
1. b and c arm, or leg, especially on one side of the
2. 1. You can save or restore a patient’s life. body or on both sides.
2. You can help reduce a patient’s recovery b. Sudden confusion or drowsiness.
time; either in the hospital or at home. c. Trouble speaking, understanding or
3. You can make the difference between a swallowing.
patient having a temporary or lifelong d. Sudden vision trouble from one or
disability. both eyes.
3. 1. Anxiety e. Sudden trouble walking, dizziness,
2. Guilt loss of balance or coordination.
3. Fear of imperfect performance f. Sudden severe headache with no
known cause.
4. Fear of making a person worse
14. c
5. Fear of infection
15. Cardiopulmonary Resuscitation
6. Responsibility concerns
16. C=Chest Compressions
4. True A=Airway Open
5. a, b, c, d, f, g B=Breathing for Patient
S=Serious Bleeding
6. a. Early Recognition and Call for Help
17. a
b. Early CPR
18. a = Bright red blood that spurts from a
c. Early Defibrillation wound in rhythm with the heartbeat.
d. Early Professional Care and Follow-up b = Dark red blood, steadily flowing from a
7. b wound without rhythmic spurts.
8. Ask a bystander to call EMS and secure an c = Blood slowly oozing from the wound.
AED if possible. If you are alone, use your 19. a, b, c, d, e, g, h, i, j
mobile phone to call EMS. If you do not
have a mobile phone, leave the patient to call 20. a, b, c, d, e, f
EMS if no other option exists.
9. Answer varies. Should be the appropriate
emergency number for the local area or
country.
10. You really cannot make the person worse.
A person that is unresponsive and not
breathing normally is already in the worse
state of health possible since he probably
does not have a heartbeat.
11. True
12. a
13. a. Sudden weakness or numbness of the face,
A-2
Appendix
Participant Manual
Secondary Care Knowledge Review Answer Key
1. b
2. b
3. physical harm to the body
4. an unhealthy condition of the body
5. a
6. life threatening
A-3
Primary and Secondary Care Instructor Guide
1. In Emergency First Response courses, you learn to 5. Why should you assist someone who needs
provide emergency care based on the same priorities emergency care.
used by medical professionals to assist injured or ill A You can save or restore a patient’s life.
persons. B You can help reduce a patient’s recovery time.
A True B False C You can make the difference between a patient
having a temporary or lifelong disability.
2. Why is time critical when someone needs emergency
care? D All of the above.
A The chances of successful resuscitation diminish 6. Using the Chain of Survival illustration on your
with time. answer sheet, write the appropriate letters in the
B It becomes impossible to administer first aid. boxes to describe each of the links.
C Emergency Medical Services are typically. A Early Recognition and Call for Help
far away. B Early Professional Care and Followup
D All of the above. C Early CPR
3. Why might a person hesitate to provide emergency D Early Defibrillation
care to an individual.
A Anxiety
B Fear of imperfect performance
Chain of Survival
C Fear of infection
D All of the above
Product No. 71825 (12/11) Version 1.0 © Emergency First Response, Corp. 2011
® indicates a trademark is registered in the U.S. and certain other countries.
A-4
Appendix
8. Each time you perform CPR, the patient’s heart 13. What two ways can you recognize cardiac arrest in a
will restart and you will restore the patient’s life. patient? (Check two responses.)
(Check your response.) A The patient does not respond when you
A True B False speak to or touch him.
B Paralysis of the arm.
9. From the introductory statements below, which one
C Bleeding from the nose and mouth.
would you select when asking permission to help a
patient? (Check your response.) D The patient is not breathing normally.
A Hello? My name is ______, I’m an Emergency 14. How do you activate the Emergency Medical Service
Responder. May I help you? in your area?
B I’m a doctor. May I help you? Phone Number: _____________________________
C Are you hurt? Where?
D None of the above. 15. Common signs and symptoms of stroke include:
(Check all that apply.)
10. If you perform CPR as outlined in this course, you A Sudden confusion or drowsiness
really can not make the patient worse than when you B Sudden weakness or numbness of the face, arm,
first found the individual. or leg
A True B False C Sudden vision trouble from one or both eyes
11. As an Emergency Responder what general rule may D Bleeding from the nose
help you avoid infection by bloodborne pathogens?
A Always place a barrier between you and any
moisture or fluid originating from a patient.
B Ask the patient not to cough when you are giving
him emergency care.
C Have the patient bandage his own bleeding
wounds whenever possible.
D Always use gloves when treating a patient.
AB C
Airway Breathing
Open? Normally? A
B
S Shock
Spinal Injury
A-5
Primary and Secondary Care Instructor Guide
16. The universal sign that someone is choking is: 20. Arterial bleeding can be recognized when:
A Sudden unconsciousness. A dark red blood steadily flows from a wound
B Pointing to the throat. B blood slowly oozes from a wound
C Grabbing or clutching neck or throat. C blood is coming only from an arm
D None of the above. D bright red blood spurts from a wound in a
rhythm with heartbeats
17. CPR: (Check all that apply.)
A Stands for Cardiopulmonary Resuscitation. 21. What are indications of shock? (Check all that apply.)
B Is a two step process - chest compressions and A Pale or bluish tissue color
rescue breaths. B Altered consciousness
C Is an interim emergency care procedure until an C Lackluster eyes, dazed look
AED or EMS personnel arrive. D. Rapid, weak pulse
D Should not be used to assist an unresponsive
patient that is breathing normally. 22. Indications that someone might have a spinal injury
include: (Check all that apply.)
A Headache
B Vomiting
C Change of consciousness - like fainting
D Pain in back of neck area
A-6
Appendix
25. In what circumstances should you always suspect a 31. If you are unable or feel uncomfortable giving a non-
spinal injury? (Check all that apply.) breathing patient rescue breaths you should:
A Lightning strike A Go ahead and give continuous chest
B A penetration wound, such as a gunshot compressions.
C Falling from a height greater than victim’s own B Do nothing at all.
height C Yell for help.
D Swimming pool, head-first dive accident D None of the above
26. The head tilt-chin lift method is used to open a 32. ____________ is the first and most successful
patient’s airway. method for serious bleeding management.
A True B False A Yelling for help
B Sustained direct pressure
27. An unreponsive, breathing patient without a C Elevating the wound area
suspected spinal injury should be:
D Tourniquets
A Given CPR immediately.
B Moved immediately to a hospital. 33. While managing serious bleeding, if a pressure bandage
C Placed in the recovery position. or dressing becomes soaked with blood, you would
D Given back blows. generally remove it and replace it with a new one.
A True B False
28. If an unresponsive, nonbreathing patient’s problem
could be a drowning or other respiratory problem, 34. Shock management often includes elevating the
you _______ then call Emergency Medical Services. patient’s legs 15-30 centimetres/6-12 inches and
A treat for shock ________________.
B give Care First A performing a pulse check
C give rescue breaths first B providing water to drink
D place the patient in the recovery position C taking the patient’s temperature
D protecting from the sun or covering the patient
29. During CPR the ratio of chest compressions to to maintain body temperature based on local
rescue breaths is: climate
A 10 compressions to 1 breath
B 15 compressions to 2 breaths 35. A _____________ allows you to turn a patient on
his back carefully when a spinal injury is suspected
C 30 compressions to 2 breaths
(Check your response.)
D 100 compressions to 2
A log roll
30. During CPR the rate of chest compressions per B fireman’s carry
minute is at least: C hand carry
A 200 D pressure bandage
B 50
C 100
D 150
A-7
Primary and Secondary Care Instructor Guide
A-8
Appendix
8. During an illness assessment you use the mnemonic “SAMPLE” to guide you.
SAMPLE stands for: (Write in the correct meaning of each letter.)
S= ______________________________________________________________________________________
A= ______________________________________________________________________________________
M = ______________________________________________________________________________________
P= ______________________________________________________________________________________
L= ______________________________________________________________________________________
E = _______________________________________________________________________________________
A-9
Primary and Secondary Care Instructor Guide
Directions: Upon making your answer choice, COMPLETELY fill in the space below the proper letter.
If a mistake is made, erase your selection or place a dark X through your first answer.
A B C D 13. □ □ □ □
1. True
False 14. Phone Number:
2. □ □ □ □ ____________________
3. □ □ □ □ 15. □ □ □ □
4. □ □ □ □ 16. □ □ □ □
5. □ □ □ □ 17. □ □ □ □
6. 18. □ □ □ □
19. □ True □
False
20. □ □ □ □
21. □ □ □ □
22. □ □ □ □
23. □ □ □ □
24. □ □ □ □
7. □ □ □ □
25. □ □ □ □
8. □ True
False
26. □ True
False
9. □ □ □ □
27. □ □ □ □
10. □ True
False
28. □ □ □ □
11. □ □ □ □
29. □ □ □ □
12. Cycle of Care: AB-CABS™
30. □ □ □ □
Help or AED Arrives
Continue Until 31. □ □ □ □
C 32. □ □ □ □
AB
Airway Breathing 33. □ True □
False
Open? Normally? A
34. □ □ □ □
B 35. □ □ □ □
S Shock
Spinal Injury
STUDENT STATEMENT: I have had explained to me and I understand the questions I missed.
Student Signature __________________________________________________________________________________
Date _____________________________________________________________________________________________
Product No. 71826 (07/11) Version 1.0 © Emergency First Response Corp. 2011
® indicates a trademark is registered in the U.S. and certain other countries.
A-10
Appendix
Directions: Upon making your answer choice, COMPLETELY fill in the space below the proper letter.
If a mistake is made, erase your selection or place a dark X through your first answer.
A B C D
1. □ □ □ □
2. □ □ □ □
3. □ □ □ □
4. □ □ □ □
5. □ □ □ □
6. □ □ □ □
7. □ □ □ □
8. S = __________________________________
A = __________________________________
M = _________________________________
P = __________________________________
L = __________________________________
E = __________________________________
9. □ True □
False
10. □ □ □ □
STUDENT STATEMENT: I have had explained to me and I understand the questions I missed.
A-11
Primary and Secondary Care Instructor Guide
Directions: Upon making your answer choice, COMPLETELY fill in the space below the proper letter.
If a mistake is made, erase your selection or place a dark X through your first answer.
A B C D 13. 7 □ □ 7
1. 7 True □
False 14. Phone Number:
2. 7 □ □ □ ___(Answer varies)_____
3. □ □ □ 7 15. 7 7 7 □
4. 7 □ 7 7 16. □ □ 7 □
5. □ □ □ 7 17. 7 7 7 7
6. 18. 7 □ □ □
19. □ True 7
False
20. □ □ □ 7
21. 7 7 7 7
22. 7 7 7 7
A C D B 23. □ □ 7 □
7. □
7 □ □ 24. 7 7 7 7
8. □ True False
7 25. 7 7 7 7
9. 7 □ □ □ 26. 7 True
False
27. □ □ 7 □
10. 7 True False
28. □ 7 □ □
11. 7 □ □ □
29. □ □ 7 □
12. Cycle of Care: AB-CABS™
30. □ □ 7 □
Help or AED Arrives
Continue Until 31. 7 □ □ □
C 32. □ 7 □ □
AB B
Airway Breathing 33. □ True 7False
Open? Normally? A D
34. □ □ □ 7
B A 35. 7 □ □ □
C
SS hock
Spinal Injury
STUDENT STATEMENT: I have had explained to me and I understand the questions I missed.
Student Signature __________________________________________________________________________________
Date _____________________________________________________________________________________________
Product No. 71827 (09/11) Version 1.01 © Emergency First Response Corp. 2011
® indicates a trademark is registered in the U.S. and certain other countries.
A-12
Appendix
Directions: Upon making your answer choice, COMPLETELY fill in the space below the proper letter.
If a mistake is made, erase your selection or place a dark X through your first answer.
A B C D
1. □ □ □ 7
2. 7 □ □ □
3. 7 □ 7 □
4. □ 7 □ □
5. □ 7 □ □
6. 7 □ □ □
7. □ □ 7 □
8. Signs and Symptoms
S = __________________________________
Allergies
A = __________________________________
M = Medication
_________________________________
Preexisting Medical Conditions
P = __________________________________
Last Meal
L = __________________________________
Events
E = __________________________________
9. □ True 7
False
10. □ 7 □ 7
STUDENT STATEMENT: I have had explained to me and I understand the questions I missed.
Student Signature __________________________________________________________________________________
Date _____________________________________________________________________________________________
A-13
Primary and Secondary Care Instructor Guide
PARTICIPANTS
1. Name _____________________________________________________________________________________________
First Middle Initial Last
Address ___________________________________________________________________________________________
____________________________________________________________________ Phone ________________________
City State or Province Zip/Postal Code Country
2. Name _____________________________________________________________________________________________
First Middle Initial Last
Address ___________________________________________________________________________________________
____________________________________________________________________ Phone ________________________
City State or Province Zip/Postal Code Country
3. Name _____________________________________________________________________________________________
First Middle Initial Last
Address ___________________________________________________________________________________________
____________________________________________________________________ Phone ________________________
City State or Province Zip/Postal Code Country
4. Name _____________________________________________________________________________________________
First Middle Initial Last
Address ___________________________________________________________________________________________
____________________________________________________________________ Phone ________________________
City State or Province Zip/Postal Code Country
5. Name _____________________________________________________________________________________________
First Middle Initial Last
Address ___________________________________________________________________________________________
____________________________________________________________________ Phone ________________________
City State or Province Zip/Postal Code Country
6. Name _____________________________________________________________________________________________
First Middle Initial Last
Address ___________________________________________________________________________________________
____________________________________________________________________ Phone ________________________
City State or Province Zip/Postal Code Country
7. Name _____________________________________________________________________________________________
First Middle Initial Last
Address ___________________________________________________________________________________________
____________________________________________________________________ Phone ________________________
City State or Province Zip/Postal Code Country
8. Name _____________________________________________________________________________________________
First Middle Initial Last
Address ___________________________________________________________________________________________
____________________________________________________________________ Phone ________________________
City State or Province Zip/Postal Code Country
Product No. 10321 (Rev. 6/11) Version 1.02 © Emergency First Response 2011
® indicates a trademark is registered in the U.S. and certain other countries.
A-14
Instructor Name _______________________________________________________
®
Emergency First Response
Instructor Skills Completion Form
Primary Care Skills 7. Shock Management Secondary Care Skills
1. Scene Assessment 8. Spinal Injury Management S1. Injury Assessment
2. Barrier Use 9. Conscious/Unconscious Choking Adult S2. Illness Assessment
3. Primary Assessment S3. Bandaging
4. CPR - Chest Compressions Optional Skills S4. Splinting for Dislocations
Course Date 5. CPR - Chest Compressions Combined R1. AED (Automated External Defibrillator) Use and Fractures
With Rescue Breathing R2. Emergency Oxygen Use Orientation
___________ 6. Serious Bleeding Management
Participants 1 2 3 4 5 6 7 8 R1 R2 S1 S2 S3 S4
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Appendix
Product No. 10235 (Rev. 6/11) Version 2.01 © Emergency First Response Corp. 2011
® indicates a trademark is registered in the U.S. and certain other countries.
A-15
A-16
®
Emergency First Response
Illness and Injury Assessment Record Sheet
X STOP– Assess and observe scene. To help guide your assessment, remember that:
X THINK – Consider your safety and form action plan. X The average pulse rate for adults is between 60 and 80 beats per minute.
X ACT – Check responsiveness and ALERT EMS. X The average pulse rate for children is between 70 and 150 beats per
Treat patient in position found when safe to do so. minute. Toddlers will be on the higher end of this average and older
X Perform a primary assessment and monitor patient using the children will be on the lower side.
Cycle of Care. X The average pulse rate for infants is between 100 and 160 beats per
X Explain Assessment Procedure to Patient – Wear Gloves if available. minute.
X As you record information on this sheet for EMS, provide measured rates X Average breathing rate for adults is between 12 and 20 breaths per
per minute and descriptive terminology. minute. Patients who take less than eight breaths per minute, or more
Primary and Secondary Care Instructor Guide
Address _________________________________________________________ X The average breathing rate for infants (less than one year old) is
between 30 and 60 breaths per minute.
City ______________________________________ State/Province ________
X Average skin temperature is warm and skin should feel dry to the touch.
Country _________ Zip/Postal Code _________ Phone __________________ X Noticeable skin color changes may indicate heart, lung or
□ Medical Alert Tag? Type _________________________________________ circulation problems.
SAMPLE – Allergies
1. Is the patient allergic to any foods, drugs, airborne matter, etc? □ Yes □ No
If yes, what is he/patient allergic to? _______________________________________________________________________________________________
____________________________________________________________________________________________________________________________
2. Ask the patient if he has ingested or taken anything he may be allergic to: □ Yes □ No
3. Stung or bitten by organism? □ Yes □ No
SAMPLE – Medications
1. Ask the patient: Do you take medication? □ Yes □ No
If yes, what type and name? ____________________________________________________________________________________________________
2. Ask the patient: Did you take your medication today? □ Yes □ No
If yes, How much did you take and when? _________________________________________________________________________________________
3. If possible, collect all medication to give to EMS personnel and/or get name of the doctor who prescribed the medication.
____________________________________________________________________________________________________________________________
Page 2 of 4
Appendix
A-17
A-18
Illness Assessment (continued)
SAMPLE – Preexisting Medical Conditions
1. Ask the patient: Do you have a preexisting medical condition? □ Yes □ No
If yes, what type? _____________________________________________________________________________________________________________
SAMPLE – Events
1. Ask the patient: What events led to your not feeling well?
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
2. What were you doing when you began to feel ill?
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
3. When did the first symptoms occur?
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
4. Where were you when the first symptoms occurred?
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
5. Has the patient been exercising? □ Yes □ No
Page 3 of 4
Injury Assessment
History ___________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
What happened: ____________________________________________________________________________________________________________________
How did the injury happen? ____________________________________________________________________________________________________________
When did the injury occur? ____________________________________________________________________________________________________________
Injury Location (Follows Injury Assessment Order. Use Injury Key to denote condition.) Injury Condition Key
□ Head _______________________________ □ Right Arm ___________________________ A = Abrasion
□ Forehead, Cheeks, Chin _________________ □ Right Hand __________________________ B = Bleeding
□ Ears/Nose ___________________________ □ Left Arm ____________________________ Bu = Burns
□ Tracking Eyes ________________________ □ Left Hand ____________________________ C = Contusion (injury to tissues;
□ Pupils – Size _________________________ □ Rib cage ____________________________ no bone or skin broken)
Equal/Unequal ________________________ □ Spinal Column ________________________ D = Deformity
F = Fracture
Reaction to Light ______________________ □ Abdomen – Left/Right Side ______________
L = Laceration (deep/jagged cut)
□ Skull, Neck __________________________ □ Hips ________________________________ P = Pain
□ Shoulder Blades ______________________ □ Right Leg ____________________________ S = Swelling
□ Shoulders ___________________________ □ Right Foot ___________________________ T = Tenderness
□ Collarbones __________________________ □ Left Leg _____________________________
□ Left Foot ____________________________
A-19
Primary and Secondary Care Instructor Guide
1. Situational Analysis
PRODUCT PROFILE
Describe your product.
¨ Emergency First Response Primary Care (CPR) and Secondary Care (First Aid)
educational first aid training courses. The Primary Care (CPR) course prepares
participants to render aid to those with life-threatening emergencies. Secondary Care
(First Aid) builds upon what participants learned in Primary Care and helps them assist
those in need when Emergency Medical Services are either delayed or unavailable.
Primary Care (CPR) and Secondary Care (First Aid) can be offered as one complete
course or separately.
¨ The Emergency First Response Care for Children course is an innovative CPR, AED
and First Aid training course that teaches you how to provide emergency care for injured
or ill infants and children. You’ll learn the types of medical emergencies children face and
how they differ from adult conditions. The course also addresses the emotional aspects
of caring for children, secondary care for children and preventing common injuries and
illnesses in children.
The course includes both CPR and first aid skills. The primary care portion of the course
prepares you to render aid to an infant or child with a life-threatening emergency such
as choking or cardiac arrest. Secondary care focuses on developing secondary patient care
skills and building your confidence to give first aid to an infant or child in need. The Care
for Children course content is based on guidelines from the Pediatric Working Group of
ILCOR.
¨ Emergency First Response CPR and AED Course (where applicable). It encompasses
one and two rescuer CPR and AED training for adults with the option to include training
for infants and children. This is the ideal course for businesses that need to meet compliance
requirements while minimizing time spent away from the job.
¨ Emergency First Response First Aid at Work (Great Britain) and Emergency First
Response First Aid at Work (Australia). Visit the EFR Instructor Site/Continuing
Education for details on workplace courses in your area.
¨ Emergency First Response Basic First Aid (Canada) and Emergency First Response
Standard First Aid (Canada).
¨ Visit the EFR Instructor Site/Continuing Education for details on workplace courses in
your area.
A-20
Appendix
MARKET PROFILE
Summarize the existing and projected marketplace in which you will market your product (i.e.,
Emergency First Response). For example:
The market for CPR and first aid programs is extremely competitive. Internationally, there
are several established first aid organizations. Try looking up CPR and first aid training in
the local yellow pages/phone book and on the internet. This will give you an idea of currently
available programs in your local area.
In recent years, several occupations have come to require CPR and first aid training. Due to
society’s litigious nature, it is necessary for these occupations to provide their employees with
the proper training. You can use this opportunity to promote Emergency First Response.
A-21
Primary and Secondary Care Instructor Guide
STRENGTHS
Compile a list of your product’s and company’s strengths. A strength is something that currently exists
or that you hold, for example:
¨ Can offer Emergency First Response course as one complete program or separately.
¨ Offers flexibility of independent study (corporate participants spend less time away
from jobs).
¨ Educationally superior program (Meets ILCOR Standards and the 2010 Guidelines for
CPR and Emergency Cardiac Care).
¨ Will receive marketing support from Emergency First Response Corp.
¨ Can promote and sell program to an existing student base.
¨ Promotional material for consumers and corporate clients is available.
¨ CPR and AED course is competitively priced for the corporate environment.
¨ EFR consumer website is a rich source of information. You can list yourself in Course
Finder on the EFR consumer site at www.emergencyfirstresponse.com!
WEAKNESSES
Compile a list of your product’s and company’s weaknesses. A weakness is something that currently
exists or that you hold, for example:
¨ You will experience an initial learning curve.
¨ There may be limited market awareness of EFR, so you will need to expend marketing
energy.
¨ There also may be limited market awareness of your individual teaching program in the
community.
OPPORTUNITIES
Compile a list of opportunities off which you can leverage or capitalize on. For example:
¨ There is unlimited market potential, can expand beyond current student base.
¨ The market demands (or local regulations require) layperson emergency care training.
¨ Exploit training opportunities with businesses, organizations, communities, etc.
¨ Many consumers need and want this training.
¨ You can market to your current and new dive students.
THREATS
Compile a list of threats – anything that will take business away from you. For example:
¨ There are many CPR and first aid courses and they are easily accessible.
¨ The competitors are well-established.
¨ The competitors have contracts with several major companies, across all industries, to
provide their programs.
¨ Local regulations/laws governing emergency care training.
A-22
Appendix
2. Conclusions
This is where you would generalize and summarize conclusions from above SWOT (Strengths,
Weaknesses, Opportunities and Threats) analysis. For example:
Need to proactively promote the program to current student base, as well as family and
friends to begin building credibility. Collect testimonials and success stories to market to
outside businesses and organizations. Leverage as much as possible off of Emergency First
Response Corp. marketing efforts, supplementing with flyers, email initiatives, editorial/ad
space in local papers and community and school newsletters.
GOALS
Set the goals you would like to achieve as an instructor for Emergency First Response. These goals could
include the number of course completions you would like to achieve for the year, how much in sales
(gross), selling product with every course, etc. Examples include:
¨ Train 30 Emergency First Response participants in the first year (2.5 per month).
¨ Teach five corporate classes.
¨ Sell promotional materials to each class (DVDs, keychain barriers, etc.) Goal is $
(financial amount) for year.
3. Acquisition Tactics
First, order an EFR marketing kit (Product 00523) if you haven’t already received one. Next, use the
kit to help you identify specific marketing vehicles and develop a media and promotions schedule as well
as unique marketing efforts that are applicable to your area and budget. For example:
ADVERTISING
¨ Develop media strategy to maximize program and product exposure in targeted consumer
promotions.
¨ Consider banner exposure on local community web sites.
¨ Identify other vehicles such as radio, billboards, etc.
¨ Use Emergency First Response clothing, business cards, automobile signs, etc.
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Primary and Secondary Care Instructor Guide
ELECTRONIC MEDIA
¨ Evaluate promotions, contests and publicity potential.
¨ Gather testimonials from recent participants and use them to promote your courses.
¨ List all the benefits of the program and features of the product.
¨ Add your information to Course Finder on emergencyfirstresponse.com.
¨ Schedule regular (monthly) email broadcasts listing upcoming classes, promotions, etc.
¨ Begin an email database – “Emergency Care Tip of the Week.”
¨ Set up your own website with a link to the EFR consumer website
(www.emergencyfirstresponse.com).
EVENTS/SHOWS
¨ Use local town meetings, community fairs, church gatherings, Chamber of Commerce, etc.,
as a forum to provide information about the program.
¨ Attend trade shows or consider partnering with a company to display product and
provide program information.
DIRECT MARKETING
¨ Direct mail to local corporations.
¨ Follow-up all direct mail efforts with email reminders and phone calls to increase
frequency.
¨ Use direct marketing to remind past participants of refresher courses.
¨ Develop a referral card and insert it into envelope with your invoice.
4. Measurement
Make sure to measure the results of each effort.
¨ Develop internal reports to track certifications and
sales.
¨ Develop consumer surveys.
¨ Track responses to all marketing efforts (i.e., ads,
direct mail, promotions, etc.).
¨ Track satisfaction of customers and participants.
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Appendix
Marketing Presentation
Marketing Emergency First Response ®
Think back to your first CPR or first aid course and answer these three questions:
1) What made you enroll? 2) What made you choose that particular course? 3) Did you take any
other courses or go back for a refresher course from the same instructor or facility?
Chances are your answers are all very different, which makes a couple of important points. First,
people have a wide variety of reasons for wanting to learn CPR and first aid procedures. This could
range from wanting to know how to care for an ill family member, to being required to take a course
by an employer.
The second point is that in many areas there are a lot of training choices. Most people don’t have to
look too hard to find a course that fits their schedule and budget. When training is easy to find, you
need to figure out how to make your courses stand out.
The way to keep your Emergency First Response courses full involves good marketing. You need to
decide who your potential participants are and carefully craft your marketing message to appeal to
them. You also need to arrange your courses in a way that is convenient and attractive to potential
participants.
The good news is that almost everyone is a potential participant – the total market is huge. Your
marketing plan is a good way to find your niche and grow from there.
Keep in mind that besides a solid marketing plan, it is just as important to make sure that your
courses are worthwhile and enjoyable because you want participants to refer people to you and return
for emergency first response refreshers or other courses.
During this session, we’ll discuss marketing and help you start to expand your marketing plan by
sharing ideas.
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Primary and Secondary Care Instructor Guide
Overview
The CPR / First Aid Training Market
To truly understand the marketing opportunities for CPR and first aid training, you need to have an
understanding of the relative size of the market. During this segment, we’ll explore the size of the
CPR and first aid training market to identify areas of potential growth.
Potential Participants
Targeting your marketing efforts is an important part of your marketing plan. During this segment
we’ll work together to identify potential participants in the local marketplace.
Sales Techniques
Overcoming objections is a critical part of the sale process. This workshop will outline some
potential objections you may encounter when marketing EFR and ways to overcome them.
A-26
Appendix
Outline
I. CPR and First Aid Industry
A. CPR and First Aid training market
Your EFR IT will provide you with current information on market size.
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Primary and Secondary Care Instructor Guide
A-28
Appendix
A-30
Appendix
Summary
The CPR / First Aid Training Market
1. How big is the CPR and First Aid training market?
Potential Participants
2. Who are your potential Emergency First Response course participants?
Sales Techniques
8. How do you overcome objections?
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Primary and Secondary Care Instructor Guide
Responders in Action
Report Form
Responders in Action
When you use your skills as an Emergency Responder to care for an injured or ill person, we’d like to hear about it. The incident
need not be dramatic, involve a life-threatening condition or necessarily have a favorable outcome. Sharing your story motivates and
encourages others to use their skills and provide assistance in emergency situations. This information is also useful to monitor and
gauge the effectiveness of Emergency First Response training and assist in future program development.
Name ________________________________________________________________________________________________________________
Last Name First Name Middle Initial
Address _______________________________________________________________________________________________________________
Description of Events
Location of Incident _____________________________________________________________________________________________________
On the back of this form, or on a separate sheet of paper, please describe the incident, including the nature of the injury or illness,
the skills used to render aid, and if possible, information on the outcome. Please type or print neatly and submit your report to your
Emergency First Response Regional Headquarters.
□ By marking this box I understand I am granting Emergency First Response Corp. permission to reprint the details of
this incident for the benefit of other Responders. I understand details that may identify the patient will be omitted
but my name as an Emergency Responder may be used.
________________________________________________________________ ______________________________________________
Signature Date (Month/Day/Year)
Visit emergencyfirstresponse.com for the contact information of your nearest Emergency First Response Regional Headquarters.
Product No. 10237 (Rev. 6/11) Version 2.01 © Emergency First Response, Corp. 2011
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Appendix
Emergency First Response Corp. (a California corporation, hereinafter “EFR”) is the owner of certain marks,
including but not limited to, Emergency First Response, The Responder, certain logotypes - including a red heart
with a pulse mark superimposed thereon, as well as other marks, including Specialty and Certification marks.
EFR® relies upon the foregoing marks to indicate the source of origin of its services, certifications and products, so
that the public will be protected; and the instructors, participants and others associated with EFR will receive the
highest-quality services and products pertaining to their business.
To provide EFR Instructors with the ability to advertise, promote and indicate the source of origin of the EFR
services, certifications and products they provide, EFR Instructors are hereby granted a license to use the forgoing
marks on promotional materials only, specifically printed, film or video formats and software; fixed media, such
as floppy disks, hard drives or CD-ROM; or any interactive digital or broadcast media or methods, including, but
not limited to, internet or World Wide Web Sites.
The license shall not extend to the provision of other printed materials, such as manuals, books, instructions,
clothing or products or any other materials whether or not they are manufactured, sold, distributed or licensed to
others by EFR.
This license extended by EFR shall only be with respect to (1.) Printed advertising and promotional materials,
(newspaper and periodical advertisements, telephone-directory advertising, handbills and signs); (2.) Film and
video format promotional materials such as television commercials, slide shows or promotional videos; and (3.)
Software, fixed media, such as floppy disks, hard drives or CD-ROM, or any interactive digital or broadcast me-
dia or methods-based promotion, including, but not limited to, internet or World Wide Web Sites; none of which
shall include use on any item or product intended for resale. The term “Emergency First Response” may not be
used in internet domain names.
The foregoing license for advertising and promotional use shall in all respects follow the exact format, character,
general appearance, type style, background and proportions of the marks originating from EFR. In no case shall
the marks be combined with other marks, symbols, language or be in a format and appearance other than that
actually used by EFR. The full trademark must be used; truncated or partial use of a mark is not authorized.
This license shall be personal to the individual EFR Instructor and shall be nontransferable, nondivisible and not
capable of being sublicensed in any manner through any party.
Notwithstanding the foregoing, EFR shall have the sole right to disapprove of any promotional materials pre-
pared and shall be the sole judge of the criteria of whether it meets the standard of this License Agreement. To
this end, any suggestions or requests by authorized members of the EFR staff as to the usage of the marks shall
be complied with as soon as possible to avoid mistakes, deceptions, dilution or other problems that would be
detrimental to the foregoing marks.
Regardless of the foregoing license, EFR shall have the right to institute and bring any suit or any other action
necessary to protect its marks as to any person, firm or corporation now or prospectively using the marks or any
similar marks, derivations, analogs, trade names, fanciful scripts or designs.
This license shall extend for the term of authorization as an EFR Instructor, which shall be terminated forthwith
upon termination of the EFR Instructor’s relationship with EFR.
PRODUCT NO. 10299 (Rev. 6/11) Version 1.02 © Emergency First Response, Corp. 2011
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Primary and Secondary Care Instructor Guide
<Date>
<Company Name>
<Address>
<City> <State> <Zip
Thank you for your interest in <your company name> and the Emergency First Response
training program. At <your company name> we are committed to providing the utmost in
customer service and can customize Emergency First Response courses to meet your specific
emergency response/workplace safety requirements.
Emergency First Response courses are solidly grounded in state-of-the-art educational material
that provides program flexibility to meet your scheduling needs. Additionally, the courses meet
or exceed governmental authority (i.e. OSHA Or COSH)) workplace safety program
requirements for CPR and first aid training. I’ve enclosed a sample of the participant materials
for your review.
The following is a list of services and a proposal to train <number of employees> for
<company name>.
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Appendix
• invoice <company name> at <$$$> per class. Maximum class size will be limited
to twelve participants to one instructor. This fee includes all training supplies and
participant materials. Each participant will receive a personal copy of the EFR®
participant manual and video and will retain this material after completion of training.
In the event class size exceeds twelve participants, additional participants will
be billed at <$$$>. <Your company name> will invoice <company name> upon
completion of each class. Payment is due upon receipt of invoice.
• in the event of class cancellation by <company name> a cancellation fee of <$$$>
per scheduled class will be assessed.
• in the event of cancellation by <your company name>, any deposit will be refunded
in full.
Thank you for considering <your company name>for your workplace CPR and first aid training
needs. I look forward to receiving your reply by <date>. If you have any questions, please
contact me at <your contact information>.
Sincerely,
<Your Name>
<Title>
Emergency First Response
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Primary and Secondary Care Instructor Guide
Instructor Independent
Learning
The following pages cover foundational knowledge needed for the Emergency First Response
Instructor Course. The Human Body Systems segment covers how the various systems in the human
body work and how they relate to the Emergency Responder. As an Emergency First Response
instructor candidate, you’ll read this information along with the Medical Emergencies section in the
Emergency First Response Primary Care and Secondary Care Participant Manual and answer related
questions in the self-study Instructor Knowledge Reviews.
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Appendix
Most life-threatening emergencies affect one or more of the body’s three most important and
sensitive systems – respiratory, circulatory and nervous. The major organs of these three systems are
the heart, lungs, brain and spinal cord. All of the body’s systems are important, but failure of these
can cause rapid and severe damage or death.
Respiratory System
The respiratory system keeps the body supplied with oxygen and
removes carbon dioxide - the waste gas of metabolism. Breathing
is initiated when the brain detects an increase in carbon dioxide
in the blood. As carbon dioxide levels increase, the brain signals
the diaphragm, a large muscle below the chest, to flatten and push
downward. When the diaphragm flattens and the ribs are lifted up
and out, the volume of the lungs increase pulling air into the body
through the mouth or nose. Air entering the body is moistened and
filtered.
Once air enters the body, it travels around the tongue, down the
throat or pharynx and past the epiglottis – a flap that prevents food
or fluid from entering the lungs. Here, the pharynx divides into The respiratory system keeps the body
supplied with oxygen and removes carbon
two passageways, one for food (esophagus) and the other for air. The dioxide - the waste gas of metabolism.
passageway for the air is called the trachea or windpipe. The trachea
branches into the left and right bronchi, which lead into each of the
two lungs.
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Primary and Secondary Care Instructor Guide
The lungs are like sponges protected by the rib cage. In the
lungs the bronchi branch into smaller and smaller air passages.
The smallest bronchi end in thousands of tiny air sacs called
alveoli. Each air sac is enclosed in a network of capillaries.
The walls that separate the air sacs and the capillaries are very
thin. All exchange of gases in the lungs occurs in the alveoli.
Through those walls, oxygen combines with the red blood cells
and is carried through the body. Waste carbon dioxide in the
blood moves across the capillary walls, into the air sacs and is
then exhaled from the body.
The lungs are like sponges protected by the rib cage.
Importance for Emergency Responders In the lungs the bronchi branch into smaller and
smaller air passages.
Respiratory problems require the immediate attention of
Emergency Responders because without oxygen, the brain
begins to die within a few minutes. It’s important to first check Tongue
A-38
Appendix
Circulatory System
Most of the cells in the human body are not in direct contact with
the external environment. The purpose of the circulatory system is
to act as a transport service to provide these cells with the essentials
of life. The circulatory system transports both blood and lymph. The
heart, blood and blood vessels form the cardiovascular system, while
lymph nodes, lymph and lymph vessels form the lymphatic system.
Heart
Care for the central organ of the circulatory system, the heart, is of
great importance to Emergency Responders. The heart is a muscular
organ that pumps blood through an intricate network of blood
vessels. Hardly bigger than your fist and shaped like a pear, it beats
more than 70 times a minute – about 2.5 billion times in an average
life span.
The heart lies within the chest cavity, behind the breastbone and
between the two lungs. As you can see in the illustration, the heart
is vertically divided into two sides. The right side pumps blood to
the lungs, while the left pumps blood to the other body parts. Each Care for the central organ of the circulatory
side is further divided into an upper and lower chamber separated by system, the heart, is of great importance to
Emergency Responders.
valves. How the heart pumps blood to the lungs and the body can be
seen in the accompanying illustration.
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Primary and Secondary Care Instructor Guide
Lymphatic System
Like the cardiovascular system, the lymphatic system forms a vast network of vessels and is part of
the body’s circulatory system. The two primary purposes of the lymphatic system are:
¨ Returning fluids that have collected in tissues to the bloodstream.
¨ Filtering from the body, foreign particles, microorganisms and other tissue debris.
Lymph, a transparent yellowish fluid, travels through small vessels passing through small organs
known as lymph nodes. Like beads on a string, these nodes filter the lymph as it passes through. The
lymph nodes contain some of the immune system’s disease-fighting cells. Lymph nodes are grouped
primarily in the neck, armpits and groin. The spleen also contains lymph nodes and has the largest
concentration of disease-fighting cells in the body.
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Primary and Secondary Care Instructor Guide
Nervous System
All mental and physical activity is controlled by the nervous system – a
complex network of cells that communicate with one another. The division
of labor that exists within the nervous system allows it to control the
human body precisely and efficiently. As a result, a swimmer can move
through the water gracefully, an artist can paint original works and you can
learn from this knowledge development section.
The two main organs of the central nervous system are the brain and the spinal
cord. The brain is the human body’s controlling organ. The spinal cord extends
from the brain and then on to a network of nerves throughout the body.
Information transmitted to and from the brain includes:
¨ Sensory information – touch, taste, sight, sound, smell
¨ Motor functions – movement The two main organs of the central
nervous system are the brain and
¨ Involuntary functions – breathing, circulation, pulse, digestion the spinal cord.
A-42
Appendix
Skeletal System
The adult human body has more than 200 bones organized into an internal
framework called the skeleton. Bones provide a rigid framework against
which muscles can pull, give shape and structure to the body and support
and protect delicate internal organs. Bones also store minerals, such as
calcium and phosphorus that play vital roles in metabolic processes. In
addition, the internal portions of many bones produce red blood cells and
certain types of white blood cells.
Muscular System
Muscles make up the bulk of the body and account for about one third of its weight. Their ability to
contract not only enables the body to move, but also provides the force that pushes bodily substances,
such as food and blood, through the body. Tendons connect muscles to bones and ligaments are
tough bands of connective tissue that hold the bones of a joint in place. Muscles performing similar,
coordinated movements are called muscle groups. Not only do muscles generate body heat, they also
help protect much of the body’s underlying bones, blood vessels, nerves and organs. Without the
muscular system, none of the other organ systems would be able to function.
• Send someone to guide emergency services to your location, if possible. S SS erious Bleeding
hock
Spinal Injury
Product No. 00772 (Rev. 6/11) Version 2.0 © Emergency First Response, Corp. 2011
A-44
Appendix
Independent
Learning
Self-study
Instructor Knowledge Reviews
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Primary and Secondary Care Instructor Guide
Knowledge Review
Program Standards
After reading the Emergency First Response 5. Goals for both the Emergency First
Primary and Secondary Care Instructor Guide – Response Primary Care (CPR) and
Section One and the introductions to Sections Secondary Care (First Aid) courses include:
Two, Three and Four, answer the following (Check all that apply.)
questions (circle or write in your response): a. Provide a learning environment that
reduces participant anxiety, guilt and fear
1. True or False. Emergency First Response of imperfect performance.
Primary Care (CPR) and Secondary Care b. Increase the percentage of CPR and
(First Aid) courses are medically based, first aid-trained laypersons who use their
following the same priorities of care used by skills without hesitation to assist those in
professional emergency care providers. need.
c. Combine CPR and first aid into one
2. The Emergency First Response Primary simple Emergency Responder protocol
Care (CPR) course focuses on emergency that promotes long-term memory
retention.
care for _____________ situations and
d. Minimize skill development and practice
teaches Emergency Responders to use the
time, while maximizing lectures.
_________________ to continually monitor
e. Teach an internationally consistent course
a patients medical status. flexible enough to accommodate regional
a. nonlife threatening/ABCD’S CPR and first aid protocols and cultural
b. critical/ABCs differences.
c. most life threatening/Cycle of Care
d. nonbreathing/BLS 6. After successfully completing the Emergency
First Response Primary Care (CPR) course,
3. True or False. The Emergency First Response participants should be able to: (Check all that
Secondary Care (First Aid) course covers apply.)
secondary patient assessment assuming that a. Perform a scene assessment and use
Emergency Medical Services personnel are barriers appropriately.
immediately available. b. Perform a patient responsiveness check
and alert Emergency Medical Service at
4. Key features of the Emergency First the appropriate time within the primary
Response program learning philosophy care sequence.
include: (Check all that apply.) c. Determine when CPR is appropriate and
perform one rescuer, adult CPR.
a. Establishing retention through repetition
d. Splint suspected skeletal injuries.
and practice.
e. Explain the importance and timeliness of
b. Providing a low-stress educational
defibrillation within the CPR protocol.
environment.
c. Creating an encouraging atmosphere
that focuses on positive reinforcement.
d. Increasing knowledge retention through
content simplification and independent
study.
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Appendix
7. True or False. After successfully completing 12. Who may enroll in an Emergency First
the Emergency First Response Secondary Response Primary Care (CPR) course?
Care (First Aid) course, participants should a. Anyone, of any age, with an interest.
be able to perform initial and ongoing b. Adults (18 years of age or older).
assessments of an injured or ill person when c. Only people who have proof of previous
Emergency Medical Service personnel will CPR training.
be delayed. d. Anyone eight years of age or older.
8. The Emergency First Response Primary 13. True or False. People who enroll in an
Care (CPR) and Secondary Care (First Aid) Emergency First Response Secondary Care
courses are divided into what three segments? (First Aid) course having taken CPR training
a. Instructor lectures, skill demonstration through another organization need an
and skill practice orientation to these three primary care course
b. Knowledge development, skill subjects – Serious Bleeding Management,
development and scenario practice Shock Management and Spinal Injury
c. Independent study, video review and skill Management.
practice
d. Learning objectives, performance 14. The participant-to-Emergency First
requirements and skill evaluation Response Instructor ratio is:
10. Having participants study independently 16. A qualified assistant is defined as:
with the Emergency First Response a. A current Emergency First Response
Participant Manual and Video results in: Instructor.
(Check all that apply.) b. A current CPR/first aid instructor
with another regionally recognized
a. Participants who are better prepared for organization.
skill development.
c. A trained medical professional such
b. Less need to establish base concepts in as a paramedic, EMT, nurse practitioner,
the classroom, allowing more time for etc.
skill development and scenario practice
d. All of the above.
c. More time to focus on regional CPR and
first aid differences. 17. The maximum participant-to-mannequin
d. Better use of instructor and participant ratio is:
time.
a. 4:1 b. 8:1 c. 12:1 d. 16:1
11. True or False. Emergency First Response
program standards may need modification 18. True or False. It’s recommended that CPR
based on regional guidelines, laws or mannequins used for Emergency First
requirements. Response Primary Care (CPR) courses are
capable of simulating an airway obstruction if
the airway is not positioned properly.
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Primary and Secondary Care Instructor Guide
19. Which of the following items must 24. During skill development and scenario
Emergency First Response Instructors practice, the ideal practice group is made up
have when teaching the Emergency First of ________ participants playing the roles of
Response Secondary Care (First Aid) course? _______________ .
(Check all that apply.) a. 2/Emergency Responder and patient.
a. Roller and triangle bandages b. 3/Emergency Responder, patient and
b. Emergency First Response Primary and guide
Secondary Care Instructor Guide c. 3/Emergency Responder, bystander and
c. Splints victim
d. Gloves and barriers d. 4/Emergency Responder, patient, guide
and qualified assistant
20. True or False. Emergency First Response
Instructors must submit a Course 25. When using the Video Guided Approach for
Completion Authorization to Emergency skill development, place the following steps
First Response for each participant in the proper sequence (place a 1 next to the
successfully completing the course. first step, 2 next to the second, etc.)
___ Divide participants into practice
21. To keep completion cards current, groups and have them practice skill
Emergency Responders need to refresh their by referring to their Emergency First
skills every: Response Participant Manuals.
___ Introduce the skill – cover
a. 6 months
performance requirements, value and
b. 12 months briefly go over key points.
c. 24 months ___ Demonstrate the skill by reviewing
d. 36 months the critical steps.
___ Debrief the skill providing positive
22. An Emergency First Response Refresher reinforcement and suggestions for
for the Primary Care (CPR) course should improvement.
include: (Check all that apply.) ___ Show appropriate skill portion of the
a. Skill Development portion of the video.
Primary Care (CPR) course.
b. Instructor Led Knowledge Development 26. True or False. Scenario practice allows each
presentations participant to demonstrate the ability to
c. Review of any new developments or evaluate the scene, recall critical steps and
changes to primary care techniques take appropriate action.
d. All of the above.
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Appendix
Knowledge Review
Human Body Systems
After reading the section on Human Body 6. Without oxygen, the brain begins to die
Systems in the Emergency First Response Instructor within a few __________.
Guide, answer the following questions (circle or a. Seconds
write in your response): b. Minutes
c. Hours
1. What three systems of the human body d. None of the above
are most involved in life-threatening
emergencies? (Choose one.) 7. True or false. The circulatory system
a. Circulatory, musculatory, respiratory transports both blood and lymph.
b. Circulatory, respiratory, nervous 8. A healthy, average size adult’s body has about
c. Circulatory, skeletal, nervous _____________ of blood.
d. Circulatory, respiratory, lymphatic a. 3 litres/quarts
b. 6 litres/quarts
2. What is the general purpose of the c. 10 litres/quarts
respiratory system? (Check all that apply.) d. 12 litres/quarts
a. To supply the body with oxygen
b. To remove oxygen from the body 9. The purpose of blood is to: (Check all
c. To supply the body with carbon dioxide that apply.)
d. To remove carbon dioxide from a. Transport oxygen and nutrients to cells
the body b. Carry carbon dioxide and other waste
products away from cells
3. The pharynx divides into two passageways, c. Help the body defend against disease
the ___________ and the ___________. d. Help regulate body temperature
a. epiglottis/esophagus
b. esophagus/trachea 10. Which blood component is the largest?
c. trachea/epiglottis a. Red blood cells
d. trachea/bronchi b. White blood cells
c. Plasma
4. The air we breathe contains about ______ d. Platelets
oxygen.
a. 21 percent 11. True or false. Ventricular fibrillation is the
b. 30 percent term used for normal heart rhythm.
c. 50 percent
d. 72 percent 12. Contraction of the heart propels blood
through the arteries with considerable force.
5. True or false. Rescue breaths do not contain That force is called:
enough oxygen to support a nonbreathing a. Pulse
patient. b. Ventricular fibrillation
c. Artery stretching
d. Blood pressure
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Primary and Secondary Care Instructor Guide
13. When an artery is cut, bleeding 19. How is the central nervous system protected
_____________ and is _______________ in from injury? (Check all that apply.)
color. a. Tissue layers surrounding the spinal cord
a. Flows steadily/dark red b. The skull and vertebrae
b. Clots easily/bright red c. Blood vessels
c. Spurts rhythmically/bright red d. Cerebrospinal fluid
d. Oozes slowly/dark red
20. True or false. The digestive and urinary
14. Two arteries used as pressure points to reduce systems provide the body with essential
serious bleeding are the ______________ nutrients and remove waste product.
and the ____________________.
a. Brachial in the arm/femoral in the leg 21. What purpose(s) does the skeletal system
b. Carotid in the neck/brachial in the arm have? (Check all that apply.)
c. Carotid in the neck/radial in the wrist a. Support and protect internal organs
d. Brachial in the arm/radial in the wrist b. Store minerals
c. Produce red blood cells and certain types
15. Which areas of the body contain lymph of white blood cells
nodes? (Check all that apply.) d. Eliminate waste products
a. Neck
b. Armpits 22. Injuries to bones include (Check all
that apply.)
c. Groin
d. Spleen a. Sprains
b. Dislocations
16. True or false. The primary purposes of the c. Fractures
lymphatic system are to return fluids that d. Breaks or cracks
have collected in tissues, to the bloodstream;
and to filter foreign particles, microorganisms 23. Pushing bodily substances, such as food and
and other tissue debris from the body. blood, through the body is one of the primary
purposes of the _________ system.
17. The two main organs of the central nervous a. Digestive
system are: b. Musculatory
a. Heart and brain c. Nervous
b. Brain and spinal cord d. Lymphatic
c. Heart and spinal cord
d. Spleen and brain 24. True or false. Muscles need a rich supply of
carbon dioxide and nutrients delivered by the
18. What types of information are transmitted to blood to accomplish their specific jobs within
and from the brain? (Check all that apply.) the body.
a. Sensory information
b. Motor functions
c. Involuntary functions
d. Levels of consciousness
A-50
Appendix
Knowledge Review
Medical Emergencies
After reading the section on Medical 6. When transporting a dislodged tooth to the
Emergencies in the back of the Emergency First dentist:
Response Primary Care (CPR) and Secondary Care a. Keep it submerged in alcohol
(First Aid) Participant Manual: b. Keep it frozen
c. Keep it submerged in saline solution,
1. You should suspect a fracture if, after a fall or milk or water
a blow, the following signs or symptoms are d. Allow it to dry out
present: (Check all that apply.)
a. A limb appears to be in an unnatural 7. Strains and sprains are __________ muscles,
position tendons and ligaments: (Check all that apply.)
b. A limb is unusable a. Injured
c. There is rapid swelling or bruising b. Fractured
d. There is extreme pain at a specific point c. Stretched
d. Torn
2. True or false. Dislocations occur when a great
deal of pressure is placed on a joint. 8. True or false. It’s best to avoid using an area of
the body that has been strained or sprained.
3. Minor cuts, scrapes and bruises are non life-
threatening wounds which include which of 9. Patient care for a chemical splash in the
the following? (Check all that apply.) eye includes flushing the eye with water for
a. Lacerations _____________; or until EMS arrives.
b. Scratches a. 1 minute
c. Deep cuts b. 5 minutes
d. Bumps c. 10 minutes
d. 15 minutes
4. Signs of wound infection include:
(Check all that apply.) 10. Contact with electricity can cause life
a. Redness threatening injuries such as: (Check all
b. Tenderness that apply.)
c. Presence of yellowish/greenish fluid at a. Choking
the wound site b. Cardiopulmonary arrest
d. Drowsiness c. Deep burns
d. Internal tissue damage
5. To administer first aid for bruises,
apply _________ compresses, and 11. Never put ______________ on a burn.
___________________________, if possible. (Check all that apply.)
a. cold/elevate above the heart a. Ice
b. cold/splint the joints above and below b. A moist, sterile bandage
the bruise c. Butter
c. hot/elevate about the heart d. Ointment
d. hot/splint the joints above and below the
bruise
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Primary and Secondary Care Instructor Guide
12. True or false. A severely hypothermic patient 19. Patient Care for diabetic emergencies
will likely be conscious and alert, yet includes: (Check all that apply.)
shivering and displaying slightly impaired a. Giving the conscious/responsive patient
coordination. a small snack, sugar, juice, soda or candy
b. Helping the patient take a prescribed
13. _______________ affects surface skin; medication for diabetes (such as insulin)
_______________ affects entire tissue layers, c. Illness assessment, if the patient is responsive
including muscles, tendons, blood vessels and d. Looking for a medical alert tag
nerves.
a. Superficial frostbite/Deep frostbite 20. When caring for a patient having a seizure:
b. Frostnip/Superficial frostbite (Check all that apply.)
c. Deep frostbite/Superficial frostbite a. Attempt to cushion patient’s head
d. Frostnip/Deep frostbite b. Restrain the patient
c. Move objects out of the way
14. Heat stroke _______________________: d. Protect the patient
(Check all that apply.)
a. Patients have cool and clammy skin 21. A severe, life-threatening allergic reaction
b. Is life-threatening (anaphylaxis or anaphylactic shock) can be
c. Is a temperature-related injury treated by _________________________.
d. Is when the body temperature rises a. Antihistamine
dangerously high b. Epinephrine in an autoinjector
c. Antibiotics
15. True or false. Heart attack patients may deny d. Ibuprofen
that chest discomfort is serious enough for
emergency medical care. 22. True or false. Poisoning can occur through
ingestion, inhalation or absorption through
16. Patient care for a responsive heart attack the skin.
patient includes: (Check all that apply.)
a. Illness assessment 23. In the event of suspected poisoning,
b. Help patient take any prescribed contact a local Poison Control Center and
medication for chest pain _________________: (Check all that apply.)
c. Help patient into a comfortable position a. If available, explain what, when and how
d. Administer CPR much poison was ingested
b. If available, read the label on substance
17. True or false. Strokes occur when the heart for poisoning instructions
fibrillates, forcing too much blood into the c. Offer the patient food
brain. d. Save vomitus and the poison container
for EMS personnel
18. Diabetic problems, such as insulin shock,
insulin reaction or hypoglycemia, result from 24. Reaction to venomous bites and stings depends
_____________________________. on the location of the bite or sting and how
much venom was injected. The patient’s reaction
a. High blood pressure
to the venom will also depend on the patient’s
b. High blood sugar
_______________.(Check all that apply.)
c. Low blood proteins
d. Low blood sugar a. Size
b. Current health
c. Body chemistry
d. Age
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